SPOLIATION ADVISORY PANEL REPORT (ASHMOLEAN MUSEUM)

Resolved,
	That an Humble Address be presented to Her Majesty, That she will be graciously pleased to give directions that there will be laid before this House a Return of the Report from the Right Honourable Sir David Hirst, Chairman of the Spoliation Advisory Panel, in respect of a painting held by the Ashmolean Museum in Oxford.—[Tony Cunningham.]

Oral Answers to Questions

INTERNATIONAL DEVELOPMENT

The Secretary of State was asked—

Developing World (Good Governance)

David Amess: What steps he is taking to promote good governance in the developing world; and if he will make a statement.

Hilary Benn: The ability of developing countries to eradicate poverty will depend greatly on good governance. DFID works with partner countries to help them to promote safety and security, to encourage investment and growth, to improve public services and to build greater accountability, but, ultimately, developing countries themselves have to take responsibility for improving governance.

David Amess: What assessment has the Secretary of State made of the American millennium challenge account, which seeks to promote good governance by directing aid towards Governments who govern justly, try to promote economic freedom and govern in the interests of their people?

Hilary Benn: That very much reflects an American approach, which is to impose a number of requirements to enable countries to get access to the millennium challenge account funding. One consequence of that has been that the account has found it very difficult to spend money. As donors take decisions about what we do, we have to make a judgment that balances progress—because it is direction of travel that really matters—against ensuring that our money is not used corruptly or goes to purposes for which it is not intended. We make a different assessment and do it in a different way, but I think that we are all trying to achieve the same objective.

John McFall: The Secretary of State will be aware that good governance is essential for good economic management and encouraging the development of the country. On several trips to African countries, Opposition and Government MPs have stated to me that they are interested in ensuring that the budgetary process is transparent and that they wish to follow the money. Does my right hon. Friend agree that that is essential and does he have any ideas about how we could encourage African parliamentarians in that process?

Hilary Benn: I entirely agree with my right hon. Friend. That is why part of DFID's programme of work is to provide support to parliamentarians to improve accountability and scrutiny of public expenditure, working with public accounts committees in several African countries and helping to strengthen national audit functions, which allow expenditure to be assessed independently. I pay tribute to the work that organisations such as the Westminster Foundation for Democracy and the Parliamentary Network on the World Bank are doing. We should discuss among ourselves what more we might be able to do as a country, and as parliamentarians in this House, to work with colleagues in other countries to help them to build their capacity and to share experiences.

Andrew George: In respect of good governance, can the Secretary of State reassure the House that his Department is not becoming a respectable front for lax and unacceptable practices by other Departments? I expect that he will be aware that Oxfam today published a report showing that a UK subsidiary based in South Africa has been exporting military equipment to Uganda—about whose Government the Secretary of State has expressed serious concerns—thereby bypassing normal export approval processes required in the UK. Can he assure the House that the Government's welcome words about an ethical dimension to the export of military equipment will be applied in practice across all Government Departments?

Hilary Benn: I am aware of the report in today's press. The first thing to say is that were BAE Systems in the UK to have taken part in any deal, that would have been caught by the UK's trade controls. Subsidiaries cannot always operate entirely outside the UK controls—it depends on the circumstances. On the other hand, we have to recognise that exports from South Africa to another African country, with no UK involvement, are rightly a matter for the South African Government, not for the Government of the United Kingdom. The truth is that it depends on the circumstances and on the nature of the subsidiary and the extent to which it is controlled by the company in the UK.

Ann Cryer: Can my right hon. Friend comment on the governance, good or indifferent, of Sudan? Following his visit to Darfur last week, will he comment on the welfare of the people in the camps? I am particularly concerned about the welfare of women, who frequently cannot leave the camps because of the fear of being raped.

Hilary Benn: I had a conversation on that very matter with a group of women in Abu Shouk camp when I was in Darfur last week. Overall, conditions in the camps are much better than they were two years ago because of the huge international humanitarian effort. However, security outside the camps is deteriorating, which affects women who have to go out to collect firewood. I heard complaints about a lack of help and support to protect them while they do that. Jan Pronk and the new African Union force commander, Major-General Ihekire, confirmed to me that security in Darfur has deteriorated since my last visit there in June. That is why the decision that we anticipate that the African Union will take in the next two weeks to ask the United Nations mission to take over the African Union mission is so important. More troops and a stronger mandate are needed to provide protection while the parties to the conflict in Abuja get around to negotiating a peace deal. It has been going on for two years and they have not done that yet. The international community is paying the cost.
	The message that I gave last week, and that the Foreign Secretary conveyed when he was in Abuja and spoke to those taking part in the peace talks, was that we have to do a peace deal now because it is the only way that those people will go home.

Andrew Mitchell: I support the idea that the right hon. Member for West Dunbartonshire (Mr. McFall) proposed and we welcome the Secretary of State's decision to reduce British budgetary support to the Government of Uganda because of the President's failure to adhere to the principles of good governance and show respect for human rights. How did the Secretary of State respond to the Ugandan President's intemperate letter in which he complained that British aid was a "paternalistic arrangement", which held his country captive in a "beggar relationship"? Did he make it clear that we have every right to say how and where hard-earned British taxpayers' aid money should be spent and under what terms and conditions it should be disbursed?

Hilary Benn: I did indeed receive a letter last year from the President of Uganda. In correspondence and in the last conversation that I had with him in Malta at the Commonwealth Heads of Government conference, we made it clear that we will make our decisions on the basis of our assessments. Concerns about governance and especially the locking up of Kizza Besigye, the Opposition candidate in the presidential election, although he was subsequently released, led me to reallocate £15 million to helping the humanitarian situation in the north of the country, which, as the hon. Gentleman knows, is acute. We have retained £5 million and nothing will deflect us from taking the right decisions.

Andrew Mitchell: Is the Secretary of State aware that we also support his decision to reduce British aid to the Ethiopian Government? The Ethiopian Prime Minister's attitude to legitimate opposition was to gun down protesters on the streets of Addis Ababa. Does the right hon. Gentleman regret the Prime Minister's decision to include the Ethiopian Prime Minister in his Commission for Africa and to fête him at the launch of its report?

Hilary Benn: No, I do not regret that.

Andrew Mitchell: Why?

Hilary Benn: I shall explain. One should judge our development partners by what they do, and until the moment of the elections in June last year—the Commission for Africa concluded its work in March when the report was published; the hon. Gentleman must get the time scale right—the election was, in the historical context of Ethiopia, relatively free and fair and the Opposition won many seats. Subsequently, there were difficulties on the streets, people were shot dead and those who had won the seats were locked up. That is a breach of the principles on which our relationship is based. Having said that, Britain does not propose to walk away from people who are poor. That is why, like other donors, I am considering ways in which we can continue to provide help with water, sanitation and education. The people should not be punished for bad governance in their country.

Afghanistan

Roberta Blackman-Woods: If he will make a statement on aid to Afghanistan.

Gareth Thomas: At the London conference on Afghanistan at the end of January, the Prime Minister signed a 10-year development partnership agreement with President Karzai, reaffirming the United Kingdom's long-term commitment to Afghanistan. That includes £330 million of development assistance over the next three years, as part of the overall UK pledge of £500 million to help reduce poverty, improve security and governance, and tackle the opium industry.

Roberta Blackman-Woods: Following the London conference on Afghanistan, what action is the Department taking to focus attention on achieving the millennium development goals not only in Afghanistan but throughout Asia?

Gareth Thomas: One of the most encouraging aspects of the London conference on Afghanistan was the scale of the continuing international commitment to that country. Some $10.5 billion was pledged for Afghanistan for the coming years. That will help the Afghan Government to continue their programme of investing in basic resources, improving the number of functioning health clinics, rebuilding more schools and getting more teachers for them and more children back in them.
	My hon. Friend and other hon. Members may know that we are hosting a conference on the millennium development goals in Asia next week, with several senior Ministers from Asian countries coming to discuss progress and the nature of the remaining challenges.

Tony Baldry: Will the Minister explain in more detail how the alternative livelihoods programme is to be delivered in Helmand? How many UK-based staff are going to be involved? Will it be delivered through United Nations agencies, international non-governmental organisations such as Oxfam and Save the Children, or local non-governmental organisations? What are the benchmarks for success? What is the time scale involved? May we have more information about the alternative livelihoods programme in Helmand?

Gareth Thomas: The hon. Gentleman will know that the progress that we make on alternative livelihoods will inevitably depend on the security situation in Helmand and more generally, and on the ability of our development partners to work safely on the ground. He will also be aware, from his previous visits to the region and his former role as the Chairman of the International Development Committee, of the work that we have done on alternative livelihoods in other areas, encouraging access to micro-finance and the establishment of elected community development councils, and giving grants to those councils to spend on projects that people at the grass roots think are important, such as irrigation projects, roads and bridges. The progress that we make on the alternative livelihoods programme in Helmand will inevitably depend on the security situation there.

East Africa

Tony Lloyd: What discussions he has had with countries in east Africa in receipt of UK aid about the eradication of corruption.

Hilary Benn: Corruption is a serious problem in much of Africa, and it is the poor who suffer from it most. DFID and other donors regularly discuss action to reduce corruption with east African governments. In Tanzania and Uganda, the UK is supporting improvements in public financial management and greater accountability to Parliament and civil society. I had a frank discussion with President Kibaki of Kenya about corruption during my visit in January. Since then, following the publication of the Githongo dossier, three senior Ministers have stepped down due to unprecedented public pressure.

Tony Lloyd: My right hon. Friend has been suitably forthright this morning about the need to take action against corruption, and he has identified the problems that exist in Kenya and Uganda in his responses to other questions. The Museveni regime has become progressively more corrupt, and the Kibaki regime in Kenya has, sadly, not lived up to the promises of corruption eradication on which it campaigned before the last presidential election. Will my right hon. Friend tell the House how he intends to bring proper pressure to bear on those Governments while protecting the interests of the poorest people in those countries who still need British assistance?

Hilary Benn: First, by ensuring that the funds that we give are used in an appropriate way. We take great care to do that, which is why we do not provide direct budget support to Kenya. Secondly, it is right that we continue to support a process of change in those countries to create the institutions that could be used to fight corruption, if there is the political will to do so. The institutions on their own will not work, if there is no political will to make them work. What has happened in Kenya over the past month is significant because domestic Kenyan politics are leading the change, precisely because people feel disappointed. My hon. Friend is right to say that we must continue to find ways to support the poor people in those countries. Those who say that British aid to Kenya should be withdrawn completely because of the problems there are fundamentally mistaken, because that would result in punishing the poor people for failures that are not of their own making.

Andrew MacKay: I agree that funds should continue to go to Kenya, but does the Secretary of State accept that the welcome arrest of three senior Ministers is only a small step in the right direction? Is he quite happy that the Government have struck the right balance between putting real pressure on the Kenyan Government to end corruption and avoiding adversely affecting the livelihoods of ordinary people there?

Hilary Benn: In the end, it is for the House to judge whether the Government have struck the right balance, but I hope that we have. We have been resolute in making clear our concern about corruption. As I said a moment ago, I did so very directly in my recent discussions with President Kibaki. However, the most important voice that should be heard loud and clear is that of the Kenyan people, and the unprecedented events surrounding the resignation of the three Ministers is a direct result of such pressure. We need to keep that up. As I said in answer to the first question today, good governance and fighting corruption are down to the countries themselves, and the more pressure there is from within, the greater the chance of resolving the problems.

Sally Keeble: As my right hon. Friend knows, a great deal of the money that we give to Kenya goes in through organisations such as the Global Fund to Fight AIDS, Tuberculosis and Malaria. I am worried about the disbursement of the fund's money to support HIV/AIDS orphans in Kenya. What is my right hon. Friend doing, in addition to arranging our own bilateral aid, to ensure that those multilateral organisations also deal with the problems of governance, and that they arrange for effective disbursement so that the money gets through to the people who need it?

Hilary Benn: We work very hard with the Global Fund to ensure that the money and the increasing support that the Government have put in are used to good effect. Kenya is one of the countries where there have been difficulties in making the money work. Therefore, we have been supporting a programme with the Global Fund and UNAIDS to find out what the obstacles are and to ensure that that resource—that money—is delivered to change people's lives.
	While we are talking about Kenya, an immediate concern is the drought, because that will affect a lot of people, including those who have been orphaned, not least because in many cases they have lost means of support. I can tell the House today that I have decided to allocate a further £15 million in response to the latest assessment of the drought in Kenya, because there is an urgent need to get more help to people who are at risk of not having enough to eat, and therefore of dying.

Mark Simmonds: Corruption has not only robbed east Africa of resources, but exacerbated and perpetuated poverty. It hinders economic development, erodes faith in Governments and dissuades people from paying taxes. Significant progress in strengthening African nations' auditor-general capacities is urgently required. The Prime Minister has stated that aid will be linked to the elimination of corruption. What assessment has the Secretary of State made of a specific amount of British taxpayers' money allocated as aid funding that has been lost as leakage—not only to corruption, but to expenditure outside the social portfolios for which it was intended?

Hilary Benn: We have a series of procedures in place to ensure that that does not happen. I will happily give the hon. Gentleman, in the small number of cases where there have been problems, the details of what we have found and what we have done to deal with it. The way we approach the problem is, first, to make a proper assessment of the fiduciary risk; secondly, to choose how we will give our aid, in response to an assessment of the risk; and, thirdly, having made that decision, to ensure that the way the money is given is tracked carefully so that it can be accounted for.
	I take with complete seriousness my responsibility in this office to ensure that every single penny in our aid programme, for which many people have campaigned and which many people support, goes for the purpose for which it is intended.

Jim Sheridan: As with east Africa, my right hon. Friend will be aware of the absolute corruption in Nigeria and the difficulties in that country with foreign oil workers being held captive and oil production being stopped. Can I ask him about the money that is being stolen from the people of Nigeria—

Mr. Deputy Speaker: Order. I remind the hon. Gentleman and the Secretary of State that this question is about east Africa. We must move on.

Supermarket Produce

John Pugh: What discussions he has had with major supermarket chains on the promotion of produce from developing countries.

Gareth Thomas: My right hon. Friend the Secretary of State has had several discussions with Asda, whose headquarters are in his constituency. Next month, he will be meeting with Tesco and Marks and Spencer, as well as Asda and other important supermarket supply chain participants, to discuss the opportunities that their procurement practices provide, potentially, for small farmers in developing countries. [Interruption.]

Mr. Deputy Speaker: Order. Before I call the hon. Gentleman to ask his supplementary question, may I appeal to the House to keep things quieter? I need to hear the questioner, as does the Minister, and we need to hear the answer.

John Pugh: Does the Minister acknowledge that corporate responsibility from the major retailers over their supply chain and marketing can deliver enormous benefits, just as corporate irresponsibility can do the opposite? Does he acknowledge that there is more that retailers and the Government can do?

Gareth Thomas: I accept entirely the hon. Gentleman's point. Together with the International Institute for Environment and Development and the Natural Resources Institute, and as a result of recommendations made by the Commission for Africa, we have launched this initiative to look with the major supermarkets at what more we can do collectively to open up opportunities for small-scale farmers in developing countries to source goods into the UK market.

Helen Jones: Does my hon. Friend agree that, when we are encouraging supermarkets to promote more produce from the developing world, that has to be fairly traded produce? There is also a lot of work that needs to be done with consumers to encourage them to buy such produce and to help them to understand why we need to pay a fair price for those goods.

Gareth Thomas: My hon. Friend is absolutely right to make that point, particularly as Fairtrade fortnight is almost on us. I am sure that Members will have the opportunity up and down the country to contribute to consumer awareness. I pay special tribute to the Co-op Group, one of the leading UK supermarkets, which has led the way in the number of fair trade lines that it has offered. Other supermarkets are following in its wake and seeking to promote more fair trade lines. I welcome that, but, as my hon. Friend said, much more needs to be done.

Robert Key: While the Minister seeks to develop local markets in niche products, will he be careful that we do not encourage air miles and food miles, which can be hugely destructive of the global economy, and that we do not pursue a laudable aim with the wrong method?

Gareth Thomas: The hon. Gentleman is right to add that cautionary note, which is why we work closely with other Departments that focus on such issues. We can do much more to encourage access to UK markets for small farmers' goods. That is why we are working closely with supermarkets and the Fairtrade Foundation, have pledged additional resources to them and are working with the Ethical Trading Initiative.

Palestinian Authority

Andrew Dismore: What plans he has to review UK aid to the Palestinian Authority in the light of the outcome of their elections; and if he will make a statement.

Hilary Benn: The international community is united in its support for the Quartet statement of 30 January. Hamas needs to give up violence, recognise Israel and sign up to previous obligations on the peace process. Aid to the Palestinian territories will be reviewed against those principles. While the current caretaker Government are in place, the international community is examining closely what steps could help to stabilise their financial situation, as recommended by the Quartet. On Monday, the UK made £5 million available to the World Bank to transfer to Abu Mazen's interim Government. [Interruption.]

Mr. Deputy Speaker: Order. May I once again appeal for extraneous conversations to cease? International Development questions are as important as any other proceedings of the House today.

Andrew Dismore: Will my right hon. Friend make it an unambiguous precondition of continued UK aid to the Palestinian Authority that the Hamas Administration should recognise Israel, renounce violence and the Hamas-organised terror attacks that have killed 400 people and injured more than 2,400 others, and that Hamas disarms and accepts the terms of international agreements? Will he give the House an assurance that no EU or UK funding will be used to support in any way Hamas's extremist ideology and propaganda?

Hilary Benn: I can certainly give that assurance—no UK aid money will be used to support Hamas or the propaganda to which my hon. Friend refers. The international community is saying clearly that Hamas needs to take the steps set out in the Quartet statement. At the same time, everybody recognises that it is in nobody's interest that services to Palestinians—particularly poor Palestinians, who have suffered so much—should be removed because of the election process. The international community is currently grappling with that.

Zimbabwe

Nicholas Winterton: If he will make a statement on the humanitarian situation in Zimbabwe.

Hilary Benn: Zimbabwe is a country in crisis. More than one fifth of all adults are HIV-positive, 3,000 people die of AIDS every week and 1.3 million children have been orphaned. Three million to 5 million Zimbabweans face food shortages in the "hungry" months leading up to the harvest. To make matters worse, in 2005, the Zimbabwean Government destroyed the homes and livelihoods of an estimated 700,000 people in "Operation Clean-Up". DFID will spend £38 million in 2005–06 to tackle shortage of food, help to deal with HIV/AIDS and provide support for orphans and vulnerable children.

Nicholas Winterton: I am grateful to the Secretary of State for that full and factual answer. Does he go along with the United Nations, which believes that Zimbabwe is in meltdown? Not only are 700,000 people now dispossessed, but unemployment is at 80 per cent., and 70 per cent. of the population exist on one meal or less a day. What can this Government do to bring about change? How effective is the African peer review mechanism in getting Robert Mugabe to improve his human rights?

Hilary Benn: I share the hon. Gentleman's assessment of the current crisis in Zimbabwe. It has the fastest-collapsing economy in the world and is a testament to monumentally bad governance. We have discussed that at some length at Question Time today.
	We have had the European Union sanctions, and the United Kingdom is very clear in its assessment of the position and the pressure that we exert. It would be helpful if others in the international community, including those in the rest of Africa, were equally straight and honest about the cause of the problems in Zimbabwe. That would bring closer the day when the change that is needed will happen, so that the Zimbabwean people's nightmare can come to an end.

Palestine

Joan Humble: What assessment he has made of the effect of the Palestinian elections on international aid flows to Palestine.

Hilary Benn: I refer my hon. Friend to the answer I gave my hon. Friend the Member for Hendon (Mr. Dismore) a moment ago.

Joan Humble: Further to my right hon. Friend's reply to my hon. Friend, may I ask whether, if he does not receive assurances from Hamas about its involvement in terrorism, he will consider providing that essential aid for the poor people of Palestine through non-governmental organisations that will then be properly monitored?

Hilary Benn: That is one of the things that the international community will need to consider. Ultimately, it is a question of striking the balance between being absolutely clear about the principles that the Quartet has set out and which we expect Hamas to accept, and ensuring that poor Palestinians do not suffer even more. However, it will not be possible to say precisely what the alternative ways of giving support might be until it is clear what a Hamas-led Government will decide to do.

PRIME MINISTER

The Prime Minister was asked—

Engagements

Andrew Miller: If he will list his official engagements for Wednesday 1 March.

Tony Blair: Before I list my engagements, let me say that I am sure the whole House will join me in sending our condolences to the families of the two British soldiers who were killed in Iraq yesterday. They were doing a vital and important job, and we owe them a great debt of gratitude.
	I am also sure that the House will join me in sending our warm wishes to Mr. Speaker for a speedy recovery.
	This morning I had meetings with ministerial colleagues and others. In addition to my duties in the House, I will have further such meetings later today.

Andrew Miller: Let me—on behalf of the whole House, I am sure—associate myself with my right hon. Friend's remarks about the soldiers, and, indeed, the absence of Mr. Speaker.
	My right hon. Friend will know that in my constituency, local industry has done a tremendous amount in addressing issues of climate change. To remain competitive, however, industries need the strengthening of international agreements. What steps ismy right hon. Friend taking to develop such agreements?

Tony Blair: Along with my right hon. Friends the Chancellor of the Exchequer, the Secretary of State for Environment, Food and Rural Affairs and the Secretary of State for International Development, I met representatives of the "Stop Climate Chaos" coalition yesterday. We need to do three major things. First, we need to strengthen the international framework, both through the United Nations process and through the G8-plus 5 dialogue, which has been very useful indeed. Secondly, we need stronger action at European level, especially on the extension of the emissions trading system post-2012. Thirdly, obviously, we need action here. We are giving careful consideration to the idea of a carbon budget, which was advanced by the coalition yesterday. However, I think that this country has led the way over the past few years in respect of the environment and climate change, and we must continue to do so.

David Cameron: May I join the Prime Minister in expressing our sympathy for the families of the two British soldiers who died in Iraq yesterday? They died serving our country, and we should honour their memory. I also agree with what the Prime Minister said about Mr. Speaker, and wish him a speedy return.
	On a happier note, may I thank the Prime Minister for the flowers that he sent to my family? He may not know that I received flowers from both No. 10 and No. 11. I am delighted to be the first man in history to get bunched by both our Prime Ministers.
	Yesterday, the Government published their Education and Inspections Bill. The phrase "trust schools", which appeared throughout the White Paper, has now disappeared. Can the Prime Minister confirm that he is renaming those schools "foundation schools," and that they will have all the same freedoms?

Tony Blair: Let me first congratulate the right hon. Gentleman on the birth of his child, wish him and his family well, and say thank you to him for his thanks to me for the flowers? I am glad that the Chancellor was immensely generous in sending him flowers as well. Whether he will be as generous in the Budget I do not know. I certainly hope that that is the limit of his generosity to the right hon. Gentleman. We do not for legal reasons need to mention the words "trust school". It is exactly the same for specialist schools, which are not mentioned in legislation either. However, the trust schools will have exactly the freedoms that we have set out in the legislation and those freedoms will allow schools by a simple vote of their governing body to become self-governing trust schools.

David Cameron: Good, so trust schools remain. That is important. That is clear. Let me try to clarify something else. The Government's White Paper said that local authorities would not be able to provide new schools. The Prime Minister made a concession and said that they could, but that the Secretary of State for Education and Skills would have a veto. Will he confirm that, as the Bill goes through the House, that veto will remain in the Bill?

Tony Blair: It has to remain for this reason. We have made this clear all the way through. The change was made because we listened to the Local Government Association, which includes Conservative as well as Labour members, which said that, if the driving force behind this is parental choice and parents want a new community school, it seems a bit much to prevent local authorities from being in the competition to provide a new school. However, let me emphasise that, if a local authority proposes a new community school, it is not then the deciding authority. That decision is made by the adjudicator. Of course, the Secretary of State has to have the power to ensure that it is in accordance with parental choice.

David Cameron: Good, so the veto remains in the Bill. Given that the Prime Minister has our support, he does not have to make any further concessions to the rebels, so will he make it clear that the Bill will not be weakened any further?

Tony Blair: Yes, I do make that clear, but let me say to the right hon. Gentleman that I do not know whether he agrees with what we have done, with local authorities being able to propose community schools. If he does—both Conservative and Labour members of the Local Government Association have said that that should happen—that is a point of agreement between us. Also, as far as I am aware, he now supports us on selection and agrees that we should put in safeguards against selection. So we now have a very happy consensus between us and I look forward to seeing him in the Lobbies.

David Cameron: The right hon. Gentleman will see me in the Lobbies. We back school freedom. That is 200 of us. If he can just find 150 of his own MPs, we can get on and pass the Bill.
	Two former Cabinet Ministers, the right hon. Members for North Tyneside (Mr. Byers) and for Darlington (Mr. Milburn), have said that the Prime Minister's position would be untenable if he relied on Conservative support. Does he agree that that is nonsense and that he should just get on and do the right thing for school standards and for our children?

Tony Blair: We are doing the right thing for our children. What we have done so far as a result of the changes and the investment and reform in our schools is that we have raised standards substantially. We have 100,000 extra staff in our schools—teachers and teaching assistants—the biggest ever building programme for schools is under way, and this country's schools have had the best results they have ever had for children at the ages of 11, 16 and 18. We will continue to do the right thing for children in our country because we want to ensure that every child, no matter what their background, gets the best start in life.

Piara S Khabra: What information is available about the whereabouts of Osama bin Laden and what intelligence reports are available about his activities?

Tony Blair: On the whereabouts, for obvious reasons, if I knew, I could not say. In respect of the activities, there is absolutely no doubt that, around the world, al-Qaeda and linked groups are causing, and are engaged in, acts of terrorism that are killing many innocent people. Whatever part of the world it is, whether it is Iraq, Afghanistan, any of the middle eastern countries or indeed Europe, that organisation, with its evil ideology, continues to kill wholly innocent people in an attempt to destroy the values that I believe most people in the world share of democracy, freedom and respect for human rights.

Menzies Campbell: I associate my right hon. and hon. Friends with the expressions of sympathy that the Prime Minister made at the beginning and extend our good wishes to the Speaker for a speedy return.
	The Prime Minister recently described Camp X-Ray in Guantanamo Bay as an anomaly that would have to be dealt with sooner or later. When will it be dealt with—sooner, or later?

Tony Blair: As I said, I hope that a judicial process can be put in place that means that Guantanamo Bay can close, as I think it should for the reasons that I have given. However, the reason why I always qualify my answer on this issue is as follows. This arose out of the worst terrorist act that the world has ever known, in which 3,000 totally innocent people lost their lives in New York. The people who were picked up in Afghanistan were engaged in helping the reactionary forces there to defeat American and British troops. So I agree that Guantanamo Bay is an anomaly, which is why it has to end, but I am afraid that when I answer questions on it, I will always draw attention to the circumstances in which it was introduced.

Menzies Campbell: Along with the outrage of Guantanamo Bay, there remains the continuing problem of the unequal extradition arrangements between the United Kingdom and the United States. How can the Prime Minister be comfortable with an extradition treaty that results in British citizens having inferior rights to American citizens, and which the US Senate shows no signs of ratifying?

Tony Blair: I do not accept that the rights of British citizens are subject to unfairness. I am very sorry to have to say this to the right hon. and learned Gentleman and the Liberal Democrats, but I sometimes wish that they would spend a little of the effort that they put into attacking the United States on understanding why these international terrorism issues are so important, and why it is important that we stand with our allies in defeating global terrorism. [Interruption.] People can say what they like about it, but I am also entitled to say what I like about it. I find the uneven way that the Liberal Democrats always express themselves on this issue—[Interruption.] I am sorry, but I find it an affront, given what people are facing right round the world: a global terrorism that I would have thought we could unite against and defeat.

Jonathan R Shaw: Is it not the case that the terrorist attacks on Londoners last July murdered people of all faiths and were condemned by people of all faiths? If someone carries a placard announcing, "Europe, you will pay. 7/7—it's on its way", would not most British people agree that that statement glorifies terrorism? So will my right hon. Friend say to the Lords, glorification—

Mr. Deputy Speaker: Order. I think that the point has been made.

Tony Blair: The point has been made, and obviously, I agree with it.

David Cameron: On bird flu, is the Prime Minister personally convinced that all the necessary preparations have been made? In particular, are there sufficient quantities of bird flu vaccines, and when will the Government set out the circumstances in which vaccination will be used? Is it not essential that we avoid repeating the mistakes made during the foot and mouth outbreak, when decisions on such issues were made too late in the day?

Tony Blair: I do not agree with the right hon. Gentleman on vaccination. A series of people—our chief scientific adviser, the chief veterinary officer and others—advise us and sensibly we follow their advice. I am not an expert on this issue and nor is the right hon. Gentleman, but these people are. The reason why we have taken the view against vaccination, on their advice, is that they say that although vaccination is effective in stopping birds dying, it is not effective in stopping the virus spreading. Their worry has always been that vaccination masks the disease, rather than stopping it spreading. That is their reason and it is sensible in these circumstances to stick closely with the expert advice that we receive. And yes, I am satisfied that—in so far as it is possible—we have all the necessary precautions in place.

David Cameron: Yesterday, the chief scientific adviser said that he anticipates that bird flu will arrive in Britain. Why are the Government waiting until April to carry out the full field trial of their contingency plans? Is there not a strong case for bringing forward that trial?

Tony Blair: The advice that we have is that exercises engaged in during January—and during this month—provide us with a sufficient basis for the precautionary measures that we are going to take. In addition, the so-called Newcastle strain of the disease, which led to an exercise being carried out last December, has given us a fairly strong basis on which to work. But as I said earlier to the right hon. Gentleman, there are people whom we meet regularly—I met them myself just the other day—in order to be satisfied that the necessary precautions are in place. It is important that we maintain the right balance between taking the right precautionary measures and not worrying or concerning people unduly. As the chief scientific adviser said, the fact that the H5N1 virus has been found in Europe enhances the risk of it coming here. Its possible spread into poultry involves one set of considerations, but whether that transmutes into some different, human form of the virus is a completely separate issue. As I said, we get regular updates from those who advise us about the precautions that we should take, and we try to strike the balance that I set out, in the right way. I am very happy to make available to the right hon. Gentleman any of the information that we have so that he can satisfy himself on that point too.

Mark Durkan: Today is Ash Wednesday. Will the Prime Minister say that he and his Government are definitely giving up side deals in Northern Ireland for Lent—and, hopefully, for good? Will he set a date for the restoration of the institutions that are currently suspended, and call an end to the malingering and posturing of the parties involved?

Tony Blair: We will do our best to try to get an agreement, as we have over the years. However, the hon. Gentleman has long experience of dealing with these matters and will know that, in the end, the Government can facilitate but that it is for the parties involved to agree. If he can give me a little bit of help and reach agreement with the other political parties, I am very willing to come in behind him.

Nick Herbert: In the south-east, reservoirs and rivers are at their lowest levels for three decades, and hosepipe bans have been in force for seven months. Since the Government are insisting on proposals to build more than 500,000 new homes in the area, does the Prime Minister accept that they have a responsibility to deal with that deficit in local infrastructure first?

Tony Blair: It is important that we combine any development with the local infrastructure, but I hope that the hon. Gentleman understands that no responsible Government could not plan to build more homes. The country needs them, and they are a necessary consequence of any sensible housing policy for the future, but he is right: of course it is important to put in infrastructure planning at the same time, and that is what we are doing. That requires substantial extra investment, and fortunately my right hon. Friend the Chancellor has made the money available. I hope that the hon. Gentleman is not trying to suggest that it would somehow be wrong to plan ahead for the increase in housing, because it is necessary.

Joan Humble: Is my right hon. Friend aware of the work of the Commission for Social Care Inspection, and of the "Stand Up for Social Care" campaign run by Community Care magazine? The aim is to raise the profile of the 1.5 million people who work in social care. Will he ensure that adequate resources are made available, so that social care workers can be equal partners in delivering on the health and social care agenda?

Tony Blair: My hon. Friend is right, and the Government have provided some £11.5 billion for local councils for adult personal services this year, an increase of £850 million on the previous year. She is also right to draw attention to the need to continue to develop the adult social care service, and the Green Paper entitled "Independence, Well-Being and Choice" is a very important part of that. Incidentally, I also pay great tribute to the work done in this area by the voluntary sector.

Richard Bacon: Will the present inquiry by the Cabinet Secretary examine whether the Home Office acted improperly in relation to an extradition request involving Mr. Mills?

Tony Blair: We will, of course, examine any allegations that are made, and reply to them fully.

David Marshall: I trust that my right hon. Friend enjoyed the very warm welcome that he received in Aviemore last Friday, when he addressed the Scottish Labour conference and went on to break the ground for the Glendoe hydroelectric scheme. Did he notice that, after he left, the conference passed anexcellent resolution on energy that urged that consideration be given to clean coal and new-generation nuclear plants, alongside the use of renewables? Does he consider that to be the sensible approach? The Tories and the Scottish National party reject onshore wind and nuclear generation, respectively. Does he agree that they are playing fast and loose with our energy future?

Tony Blair: I agree entirely with what my hon. Friend says and I think that the position adopted by the Scottish Labour party was extremely sensible. We need all of those things together, including the renewables. We obviously need to consider the issue of nuclear power for the future and clean coal technology is also dramatically important. I hope that when we publish the results of the energy review, my hon. Friend will see reflected some of the sensible concerns that were expressed in Aviemore last week.

Robert Wilson: Does the Prime Minister agree that his Education and Inspections Bill is more radical than it first appears? Does he agree that it will deliver a final blow to the failed comprehensive education system and the overweening powers of local education authorities?

Tony Blair: Well, it is interesting that the Conservatives indicate that they are against the principle of all-ability teaching. The hon. Gentleman is a bit behind his leadership, which has switched positions on that subject over the past few months. I believe absolutely in all-ability teaching and I think that it is important. But I also think that schools should have the freedom to develop in the way that they want, within the process of all-ability teaching, and the freedom to manage their assets and staff in the way that they want. Under this Government, we have seen dramatic improvements in the number of children getting the right results, as a result of investment that the Conservative party opposed each and every point of the way.

Lindsay Hoyle: Does my right hon. Friend agree that it is totally unacceptable to have 22 per cent. price increases in gas at the same time as profits of £1.5 billion for British Gas? Has not the time come for a windfall tax to ensure investment in new gas streams in the UK and the further introduction of storage facilities in order to bring the price down to help the poor consumer?

Tony Blair: Well, I agree with my hon. Friend that there has been much concern about the recent rises. It is true that even with those increases we are still well below the EU median level and other countries have also seen significant price increases, but he is right to draw attention to the steepness of the price rises. One answer is to liberalise energy markets in Europe still further, and that is an important part of the answer. But I entirely understand the concern that he raises.

Graham Brady: Some 11,000 fewer people in Altrincham and Sale have an NHS dentist than when the Prime Minister came to power. Why does he think that is?

Tony Blair: Back in the 1990s—[Interruption.] I am sorry, but a contract was introduced by the previous Government in the early 1990s that allowed dentists to leave the NHS if they wanted to. It is the Labour party that has put more money into dentists and is hiring more dentists from overseas, but we cannot force dentists to come back into the NHS. That is why there are not more NHS dentists in the hon. Gentleman's area.

Rosie Cooper: Major cities appear to be prioritised by regional bodies in north-west transport projects. Does my right hon. Friend agree that long-standing local priorities, such as the Ormskirk bypass in my constituency, which has been second in the Lancashire priorities for the past 10 years, cannot be dismissed and demoted at a stroke?

Tony Blair: I understand entirely the concern that my hon. Friend raises and the investment in that has significantly increased. I am of course happy to look into the point that she raises and to write to her.

Susan Kramer: The Prime Minister will be aware that the family of Emily Jenkins, who was tragically killed in the 7/7 bombings, has set up a charity to post on the internet basic, non-confidential information about the victims, in a timely manner, to reunite victims and relatives. Why will his Government not give the necessary permissions for the scheme to go ahead, especially in the light of the failure of existing systems to give any timely guidance to relatives on 7/7?

Tony Blair: I thought that we had a very great deal of provision available for those families who tragically lost people in the 7/7 bombings. I am happy to look at the initiative that Beverley Chambers has put forward, and I will reflect on that and get back to the hon. Lady as soon as possible.

Jim Devine: My right hon. Friend the Prime Minister rightly congratulated the Leader of the Opposition on the birth of his son. I, too, wish him, his wife and his baby well, but I feel a little embarrassed because I have not sent him any flowers. However, should we remind the Leader of the Opposition about the Labour party's child trust fund—the so-called baby bond—which has been advantageous for many of my constituents?

Tony Blair: An immense amount has been done for children in this country, not just through tax credits but, as my hon. Friend rightly says, through the trust fund; and of course, for some of the poorest families in the country, as a result of the rises in child benefit, the minimum wage, the child care tax credit and the children's credit—all of which the Conservatives opposed—we have done an immense amount to lift children out of poverty. Indeed, about 700,000 children have been lifted out of poverty since we came to office.

Andrew MacKay: Returning to extradition, surely the Prime Minister cannot be comfortable that, as a result of his recent legislation, British citizens accused of non-terrorist offences can be extradited to the United States of America, yet the promised reciprocal legislation in America is not in place. What will he do to put pressure on the President to introduce that legislation quickly and when will it come into effect?

Tony Blair: The issue, as I understand it, is actually within Congress itself. However, it is important that we make sure that we get the reciprocal provisions in place and we will continue to do all that we can. We still believe, however, that it is right to have those extradition proceedings in place in respect of America.

Eric Martlew: The Clean Neighbourhoods and Environment Act 2005, which we pushed through the House despite opposition, gives local authorities tough powers to deal with environmental issues such as litter, fly-posting and graffiti. Is the Prime Minister convinced that local authorities will use those powers?

Tony Blair: Around 20,000 fixed-penalty notices have been issued by local authorities, but my hon. Friend is right to draw attention to the fact that not enough local authorities are using them. As I constantly say about this issue—which is linked to antisocial behaviour—we have given local communities the powers and resources but it is up to communities themselves to use them. He is right to say that local authorities now have a great deal more power than before, and fixed-penalty notices are a simple way to make sure that things such as dog fouling and littering can be easily dealt with by local authorities, but they need to use the powers they have been given.

Jeremy Hunt: Given that more than 1 million hard-of-hearing people say that they use subtitles whenever they can, does not the Prime Minister think that it sets an extremely bad example that there is no such facility on our own Parliament channel and will he take urgent action to make sure that deaf people have the same access to democracy as everyone else?

Tony Blair: For once, I am in the happy position of saying that it is not up to me to decide how Parliament arranges its affairs, but I am sure that those who are looking at these things will—[Laughter.] I do not know that an outbreak of laughter is the right response from my right hon. Friend—[Interruption.] I am sure he will. No doubt discussions in the usual channels can take place; but it is a matter not for me but for Parliament.

David Crausby: My right hon. Friend has done a fantastic job delivering lots of things—in particular, off-peak local travel for pensioners—so will he put the icing on the cake by reducing the qualifying age for a free TV licence to 65 so that our pensioners can travel, keep warm and watch the telly in peace?

Tony Blair: Well, I am not sure that I can promise to do that, but my hon. Friend is absolutely right in drawing attention to the fact that something like 3.5 million households have benefited from free TV licences. There is also the winter fuel allowance and, as he says, free travel for OAPs at off-peak times. Taken together with the money spent on pension credit, there has been a massive increase in the support that the Government have given to pensioners. In addition, incidentally, 4 million pensioner households have been lifted out of fuel poverty, so I cannot promise to do more, but my hon. Friend is entirely right to draw attention to what we have done already.

Mark Harper: In a written answer to me this week, the Secretary of State for International Development confirmed that the Government's success criterion for the alternative livelihoods programme in Afghanistan is only a 10 per cent. year-on-year increase in the uptake of legal livelihood opportunities. Is that really adequate to the challenge we face in Afghanistan, especially with the forthcoming deployment of British forces? If we fail, we shall create not stability but further insurgency, and put our troops at great risk.

Tony Blair: Of course, the hon. Gentleman is right to draw attention to the issue and the problem, but we have to make progress as we can and a lot depends on the security situation. If we can go faster, we will, but we have set a target that we believe is reasonable at the moment. What is happening in the south of Afghanistan is an attempt by al-Qaeda and the Taliban to regain control of a country that wants a democracy; millions of its people voted in democratic elections for the President and Parliament. Of course, it is important that our troops do all that they can to secure the situation so that the country can move forward in peace, but we have set targets on the change of livelihoods on the basis of advice given to us as to the realistic prospect of what we can achieve on a year-by-year basis.

David Taylor: This could be the last question in the session today. Could the Prime Minister take the opportunity to explain to the wider world why there is such wide and deep unease about the trust schools proposal among Labour Members, yet such unfettered enthusiasm among Opposition Members? Is not this politics scripted by Lewis Carroll?

Tony Blair: I will take a bet with my hon. Friend that there will be more Labour MPs than Conservative MPs in the yes Lobby for the Education and Inspections Bill. [Hon. Members: "Oh?"] Well, we will wait and see. He is entirely entitled to take the view that he does, but the reason why I believe in these reforms so passionately is that, over the past few years, we have made big improvements in our education system; but it is not good enough when, even for all the progress and improvement—far more kids are getting the GCSEs that they need at 16 than 10 years ago—40 per cent. still do not get five good GCSEs. Now in some of the poorest areas, for the schools that have been worst performing, it is necessary in my view to take radical action. We want to do that with local authorities. We want to make sure that we do it in a way that encourages schools to develop, so that every child, no matter what their background or what their class, gets the best start in life, and I think that those are good Labour principles.

Video Games

Keith Vaz: I beg to move,
	That leave be given to bring in a Bill to amend the Video Recordings Act 1984 to extend certain provisions of that Act to video games and to make provision about the labelling of video games.
	Video games have increasingly life-like graphics and antisocial themes. Their regulation has improved, but it has not gone far enough. The voluntary code must be made statutory and further safeguards put in place to protect our children.
	Over the past two years, other hon. Members and I have campaigned to control the sale of video games to young people, following the tragic death of Stefan Pakeerah—a 14-year-old Leicester schoolboy who was brutally murdered. Stefan's parents believe that the perpetrator of that savage attack was influenced by the video game "Manhunt". Stefan's mother, Giselle Pakeerah, has been campaigning to ban the sale of the game. I pay tribute to Mrs. Pakeerah—a brave and courageous mother who, in her grief, could easily have let matters pass by doing nothing, but who started an impressive campaign on this issue.
	Towards the end of 2004, Mrs. Pakeerah and I met the Prime Minister and urged him to tackle the menace of violent video games by examining the existing law governing the classification of such games and, in particular, labelling, and by requesting the British Board of Film Classification to take a more cautious approach. I am most grateful to the Prime Minister for his concern on this issue. Following the meeting, in December 2004, the Department for Culture, Media and Sport and the Department of Trade and Industry met representatives from the video games industry to consider the adequacy of existing provisions. Some new voluntary measures were introduced. New labelling for age restrictions is now twice the size it was a year ago. I welcome the industry's efforts in beginning to take action.
	I am also grateful to the Secretary of State for Culture, Media and Sport and the Under-Secretary of State for Culture, Media and Sport, my hon. Friend the Member for Stalybridge and Hyde (James Purnell), who has responsibility for the creative industries, for meeting me to discuss their Department's continuing willingness to explore ways to strengthen such protection.
	The concern about video and computer games is based on the belief that violent games are totally inappropriate for young children. Between the ages of seven and 17, children will play an average of eight hours of video games a week. However, despite recent voluntary steps, this aspect of children's entertainment is highly under-regulated. Moreover, the regulation that does exist is barely enforced.
	The video games industry in the United Kingdom is widely and rightly seen as one of our many economic success stories. The latest figures show that the software development and publishing industry in the UK is worth £711 million. Most games on the market are appropriate for young players, but the few games that feature violence, crime and antisocial behaviour have led to concerns being raised. The Bill is not intended to censor the industry. However, we must recognise that it is our duty to protect our children from inappropriate influences such as violent video games.
	The current trend in video games is for players to be the bad guys and act out criminal fantasies, earning points for attacking and killing innocent bystanders. In the forthcoming Rockstar video game "Bully", players take on the role of Jimmy Hopkins, a school boy at a boarding school. They get points for physically and psychologically tormenting other children. More than 50 Members have signed early-day motion 1172, which calls for the game to be banned.
	The 2004 game "Grand Theft Auto: San Andreas" has been among the top 10 best-selling games for the past two years and has sold a total of 12 million copies worldwide, including 1 million copies in the United Kingdom in the first nine days after its release. The game contained a hidden code that could be unlocked by players and which introduced to the game scenes in which characters performed sexually explicit acts. Following campaigns in the United States, the publishers were forced to recall and rewrite the game to remove the hidden code.
	Although those games are rated 18 for adult audiences, they are extremely popular among young people. This type of content is wholly inappropriate and unacceptable, but, regrettably, that is the path down which the games are heading. British research into the effects of video games has been inconclusive so far. A number of studies, including research published by DCMS today, have found no conclusive evidence that video games can influence children's behaviour. However, studies into the long-term effects of video games are in their infancy and are at best speculative. Due to ethical difficulties associated with exposing children to adult material, it is difficult to secure conclusive evidence either way—difficult, but not impossible.
	On 25 January 2006, during Prime Minister's questions, I raised the findings of new research published by Professor Bruce Bartholow of the university of Missouri-Columbia last year, which shows that people who play violent video games become desensitised to violence and are more likely to commit aggressive acts. It is the first research to show that playing violent video games diminishes brain reactions to violent images. It shows a link between the playing of violent video games and a propensity to commit aggressive acts. Those who believe that violent video games have no effect on the person playing them are ignoring the facts. The link exists and should give us great cause for concern.
	The implications of the research, which was published in the Journal of Experimental Social Psychology, are far-reaching. Every precaution should be taken to ensure that children are not exposed to games that will diminish their sensitivity to violence. Children need to be protected from violent games for this reason: although a child's morality continues to grow and mature as they grow older, they are still immature and lack the necessary capabilities to deal with the exposure to violence that these games give them. The warnings offered by the research need to be taken seriously and should urge us all towards cautionary, preventive regulations to protect our children.
	At the moment, regulation is very confusing, as two rating systems are in use: the British Board of Film Classification, which rates about 2 per cent. of games, and the voluntary PEGI, or pan-European game information, system. The director of the Entertainment and Leisure Software Publishers Association, Roger Bennett, concedes that the ratings are not always clear. He states:
	"BBFC ratings are on the front of games boxes, while ELSPA's are on the back. If a game does not have a BBFC rating, people sometimes assume it is suitable for children, forgetting to check the back."
	Furthermore, a study by the Swiss firm Modulum showed that
	"parents perceive age ratings as a guide but not as a definitive prohibition".
	Current regulations are often ignored by retailers. An investigation for "Tonight with Trevor McDonald" in November 2004 uncovered the fact that children as young as 12 had managed to buy adult video games. Over two thirds of 11 to 14-year-old boys questioned admitted to playing video games with an 18 certificate. On camera, children between the ages of 12 and 14 were shown buying adult video games from Tesco, Virgin, Dixons, John Lewis, Sainsbury's and Asda.
	Other countries have adopted a different approach. In Canada, in the European Union and even in the United States, action has been taken. This Bill will make it a requirement not only to have a larger sign indicating the certificate but to have an accompanying description of the content that led to the game being given that rating.
	This is not about adult censorship; it is about protecting our children. We need to act now before it is too late.
	Question put and agreed to.
	Bill ordered to be brought in by Keith Vaz, Annette Brooke, Mrs. Betty Williams, Mr. Edward O'Hara, Mr. Elfyn Llwyd, Mrs. Iris Robinson, Jessica Morden, Miss Julie Kirkbride, Mr. Mike Hancock, Sir Nicholas Winterton, Mr. Stephen Crabb and Derek Wyatt.

Video Games

Keith Vaz accordingly presented a Bill to amend the Video Recordings Act 1984 to extend certain provisions of that Act to video games and to make provision about the labelling of video games: And the same was read the First time; and ordered to be read a Second time on Friday 12 May, and to be printed [Bill 136].

Opposition Day
	 — 
	[14th Allotted Day]

Dentistry

Mr. Deputy Speaker: I must announce to the House that I have selected the amendment in the name of the Prime Minister and placed a 10-minute limit on Back-Bench speeches. May I also add that the amount of time available to Back Benchers will depend to a great extent on the restraint shown by the three Front-Bench spokesmen?

Andrew Lansley: I beg to move,
	That this House supports the achievement of good oral health through the provision of NHS dentistry; calls, therefore, on the Government to fulfil its commitment that everyone should have access to NHS dentistry; is alarmed that the British Dental Association regards the new dental contract as 'a shambles' and is concerned that many dentists will reduce their commitment to NHS dentistry; and further calls on the Government to withdraw the National Health Service (General Dental Services Contracts) Regulations 2005 and the National Health Service (Personal Dental Service Agreements) Regulations 2005 and immediately to re-open negotiations with the dental profession on dental services contracts which are piloted and linked to patient registration and capitation payments, support for preventative work and the achievement of good oral health.
	In September 1999, the Prime Minister said that by 2001 everyone would have access to NHS dentistry just by calling NHS Direct. Six years after he made that pledge fewer people than ever are registered for NHS dentistry. In those six years we have seen queues forming outside the premises of NHS dentists who are opening up their registrations. We may not see that in future because the Government propose that people will not be able to queue outside NHS premises to be registered; they will have to register by letter or by telephone—queuing is too embarrassing. Indeed, the situation has now become so bad that the public are queuing outside private dentists.

Anthony Steen: Patients in Torbay are being told that they must not queue outside any new NHS dentist. I am advised that they have received letters informing them that it would be embarrassing for the primary care trust to have people queuing because it knows that so many people want dental treatment and that there are so few NHS dentists. Is that not outrageous?

Andrew Lansley: It is outrageous.
	I visited Torbay before the last general election and talked to the secretary of the local dental committee. If I recall correctly, the number of patients registered in south Devon was under 30 per cent.—among the lowest in the country. Indeed, the number in my constituency was also among the lowest in the country.

Bob Spink: A Castle Point dentist and a local dental committee secretary, Mr. Foreman, states in a letter dated 21 January:
	"Under the terms of the new contract our CACV has been reduced by some 80 per cent. from our historic NHS gross average."
	Dentists in Castle Point do a great job and we must fund them properly. We must stop ill-thought-out cuts. Does my hon. Friend agree that the Government's policy is a shambles and will reduce the number of NHS patients?

Andrew Lansley: My hon. Friend is absolutely right. It is not only me who thinks that the policy is a shambles. The British Dental Association also thinks that it is a shambles. The association said that Ministers conducted the contract negotiations leading to a new dental contract with "extraordinary ineptitude". It described it as a "shambolic process". It has been a shambles. Over recent years, dentists have reduced their commitment to the NHS because they have been on a treadmill of drill and fill. We have known for years that change is necessary. That was why the Conservative Government, before the 1997 general election, introduced legislation that established primary care trusts and personal dental services contracts.
	The Government have pursued a new dental contract based not on new ways of working but on targets. They propose a target-driven process that does not recognise the needs of the profession or of patients.

Damian Green: My hon. Friend and the Minister might be interested in an e-mail that I received a few days ago from a constituent. It reads:
	"Since I moved to Ashford some 40 years ago I have attended the same dental practice. Last Tuesday, after my six-months check-up, I was advised that due to Government contract changes I would not be able to make a new appointment."
	That is what dentists believe and that is what their patients believe. Contract changes are driving people away from the NHS.

Andrew Lansley: I am grateful to my hon. Friend for that intervention. His experience is the same as mine in Bar Hill in my constituency, where a dental practice has walked away from a new dental contract. That experience is mirrored throughout the country.

Graham Stuart: I thank my hon. Friend for visiting the town of Hornsea in my constituency. As he knows, it is an isolated rural town. It is the largest town in the country without an A-road into it. The threat, when he visited the town, concerned community hospitals. That threat still remains. However, there are three dental practices in the town, two of which have announced in the past week that, thanks to the Government's shambolic handling of dental contracts, they are leaving the NHS. Seven thousand fewer of my constituents are now registered with NHS dentists than before the Prime Minister's promise was made.

Mr. Deputy Speaker: Order. I should have added that the length of interventions will have some impact on opportunities to participate later in the debate.

Andrew Lansley: I am grateful, Mr. Deputy Speaker, but I am grateful, too, to my hon. Friend the Member for Beverley and Holderness (Mr. Stuart) for making that important point. Apart from persistent inequalities in terms of dental outcomes and dental health, inequality is increasingly apparent in terms of access to NHS dentistry, all of which is a condemnation of the Government.

Edward Balls: rose—

Andrew Lansley: How can I resist the hon. Member?

Edward Balls: I am grateful to the hon. Gentleman for reminding us of a previous Conservative Government with his reference to funding issues. On the "Today" programme this morning, the Leader of the Opposition confirmed that it was his party's policy to introduce a third fiscal rule—the proceeds of growth rule—which would mean that spending would fall as a percentage ofgross domestic product under a Conservative Government. Does the hon. Gentleman expect the NHS and dentistry to be carved out of that rule, or does he expect it to apply to them too? If so, public spending would fall as a percentage of GDP on dentistry services.

Andrew Lansley: I am grateful to the hon. Gentleman, whose point comes from the bottom of page 2 of the Labour party briefing—we will see if we reach the rest of those listed. One would have thought that the hon. Gentleman could at least write his own interventions. We made clear before the election what we intended to do about dentistry, and our proposals would have made an enormous difference. I do not know whether the hon. Gentleman in his previous occupations had occasion to read "Proposals for modern oral health", which was published in October 2004 by the Conservative party, but before the election we set out proposals based on registration
	"to encourage an ongoing relationship for patients with a general dental practice."
	The Government, however, propose to abolish registration. We proposed, too, a shift from fee-based remuneration to capitation. The Government propose to retain an activity-driven system, instead of introducing a system in which finances are driven by the number of patients on a practice list. We proposed a low-cost monthly payment scheme for non-exempt adults—the Government propose to increase the charges for patients—and oral health promotion focused on children. The Government, however have enabled primary care trusts—and, in some respects, they have encouraged them—to refuse children for treatment and exempt adult contracts for dentists. Finally, we proposed an
	"evidence-based schedule for NHS dentistry designed by the National Institute for Clinical Excellence".
	At least the Government have begun to introduce that proposal.

Edward Balls: Will the hon. Gentleman give way?

Andrew Lansley: No, of course not. If the hon. Gentleman does not have anything original to say, I am not going to help him.

Douglas Hogg: Will my hon. Friend include in his policies a commitment that the Government of the day should fund private dental care if someone is wholly unable to obtain NHS dentistry because none is available?

Andrew Lansley: I am grateful to my right hon. and learned Friend, but I am not going to make that pledge. My objective, and the objective of the Conservative party, is to secure access to NHS dentistry for people in this country on an equitable basis. Inequalities of access have given rise to the need for a new contract. The purpose of the motion is to make the Government realise that it is the eleventh hour—it is one month to the day before the new dental contract comes into force. The profession are against the contract, and it profoundly disagreed with it in earlier discussions. The Government, however, refused to listen. In December last year, the British Dental Association literally walked away from the negotiations, and said that talking to the Government was akin to a one-way street. It talked to the Government, but the Government did not respond.

Mark Pritchard: rose—

Andrew Lansley: I shall give way to my hon. Friend, as I know that he is anxious to contribute.

Mark Pritchard: I am always anxious to contribute to debates secured by my hon. Friend. Does he agree that there is concern about oral health because of the lack of access to dentists, and that cancers of the mouth may increase and orthodontic provisions could be affected?

Andrew Lansley: That is absolutely right. A central reason why dentists as a profession want to spend more time with patients is that they want to undertake proper preventive work and good oral health work. In the mechanics of the contracts, the Government have not taken proper account of the time that it takes for new orthodontic practices to establish their work. Practices across the country, including one in my own constituency, have written to me,because they have been offered a contract that dramatically underestimates the amount of work that they need to do. The base year or target year did not include their work because they had established themselves more recently.
	The dentists walked away from negotiations with the Government, so the Government proceeded on the wrong basis. They did not introduce proposals based on registration or a capitation system. Their proposals did not encourage preventive work or promote good oral health. They should work with the profession, rather than against it. Not only is the profession against the Government, but this morning, Which? published a survey in which 79 per cent. of the public said that they do not trust the Government to improve dentistry in the next year. The profession and the public are saying the same thing, so the Government must think again. The motion is designed to make sure that they do so. The contract is a shambles, and it is not based on the primary dental services pilots. It does not include a UDA system. I apologise to the House. There are no Northern Ireland Members in the Chamber, but by "UDA" I mean "units of dental activity". The personal dental services contracts were not established on that basis, although the UDA system allows dentists to spend more time with patients and takes account of the size of patient lists. The Government would not proceed with such proposals, which is tragic.

Ann Winterton: Is it not irresponsible of the Government to introduce an untried and untested system, which is causing chaos throughout the United Kingdom, and will not achieve their aim of improving the quality of care for patients, securing access to dentistry and improving the nation's oral health?

Andrew Lansley: My hon. Friend is right, and has captured the profession's view. I have already cited the British Dental Association, which has said:
	"The new contract will not secure patient access, improve oral health or raise the quality of care."
	Those are the things that we are supposed to target, but the Government are not setting out to achieve them. The contract is seriously flawed.

David Tredinnick: Leicestershire primary care trusts have a £6 million shortfall, so it will be impossible to deliver even the care that is available this year. That is on top of the complaints by the Leicestershire local dental committee, which is almost unanimously against the proposals, particularly the decision to charge on a treatment basis rather than per visit.

Andrew Lansley: My hon. Friend is quite right. The pictures of people queuing for a dentist in the Leicester Mercury are testament to the difficulties that they are facing in the light of the withdrawal of services. The Secretary of State has not bothered to stay in the Chamber to discuss dentistry, but there are dental practices in her own constituency that have written tomy hon. Friend the Member for Westbury (Dr. Murrison) to say that they have ceased to provide NHS dentistry. We need a new contract. Not only do practices find it impossible to secure contracts that will enable them to continue to look after their patients—90 per cent. have experienced difficulties with contract values—but, as I have said, they have lost the ability to charge for missed appointments. They can no longer offer services to exempt adults and children.

Rosie Winterton: Absolutely.

Andrew Lansley: Well, there is a problem with which we must deal, as some dental practices say that adults can only register their children for NHS work if they enter into a private contract themselves. PCTs, however, have told practices that they cannot offer a contract to treat children and exempt adults on the NHS, whether or not the practice has made that condition. Children have therefore been thrown off NHS lists, even though their dentist is willing to offer NHS dentistry.

Rosie Winterton: As the hon. Gentleman knows, because of demands in this House dentists were following exactly the practice that he outlined by saying, "We'll take your children on the NHS if you as parents go privately." There can still be children-only lists under the new system. I am sure that he agrees that if primary care trusts believe that it is better for dentists to offer services to children and parents at the same time, it is absolutely right that they have the discretion to do that.

Andrew Lansley: As the BBC survey said this morning, 5 per cent. of primary care trusts are saying that one cannot have exempt adult and children-only lists. I know why they are resisting it—because then there is no patient income.
	That brings me on to another essential point—charges. The British Dental Association has accused the Government of using the new contract as a revenue-raising measure contrary to the principles of the national health service, yet this is a Government who talk about a free NHS. In 2004–05, dental charge income was £465 million; in 2006–07, it will be £623 million. Those are the Government's own figures. I only received the latest figures this morning, having asked the question in November—we can only get information out of the Government by bringing this debate to the Floor of the House. That is a 28 per cent. real-terms increase in dental charge income. The Government's contribution to dentistry over those same two years is rising by just 9 per cent.
	That is completely contrary to the Government's previous claim that the contribution made by patients towards the cost of dentistry would remain the same. In fact, it is rising—I have just stated the figures. There are three bands of charges. That is simpler, but not necessarily fairer. For example, a check-up will cost £15.50 instead of £5. Lord Warner, the Minister in the other place, said that 42 per cent. of patients get their treatment in band 2 and, of those, three quarters will pay more under the new system. That is what is going on—more charging and more costs for patients. Of course, the Government will parade the fact that £2.7 billion is being spent on dentistry, neglecting to say that the cost of dentistry to patients has increased by one third, on the Government's figures, in the space of two years.

Stephen McCabe: rose—

Andrew Lansley: Perhaps the hon. Gentleman would like to explain that.

Stephen McCabe: Given the hon. Gentleman's concern about charges, does he agree that there is something unethical—indeed, perhaps involving a breach of data protection legislation—in dentists who are voluntarily opting out of the NHS writing to patients to advise them of private insurance arrangements without disclosing the benefits that they themselves stand to make? Is that appropriate?

Andrew Lansley: I can understand that the hon. Gentleman is embarrassed that dentists are leaving the NHS and writing to their patients, but that is, regrettably, what is happening. They have a relationship with patients and are contacting them to give them details of what they are proposing to do. Instead of the hon. Gentleman criticising dentists, it would be better if he and his hon. Friends tried to work with them. The dentists we have talked to who are leaving NHS dentistry or reducing their commitment to it deeply regret having to do so.
	The way forward is clear. Many dentists who sign up to the contract will do so reluctantly. They will be very unhappy with the straitjacket of activity targets that they are being put into. If they start to move beyond the 4 per cent. tolerances, they will find that they have no confidence that contract values will be honoured in future. They may well find that penalties are imposed on them. As time goes on, particularly as the income protection period expires, many will say that they are going to give up and go outside the NHS. A third of the dentists who got together in Birmingham at the local dental committee said that they would not sign the contract, and dentists in many other parts of the country are saying the same.
	Instead of dentists reducing their commitment, we must go in the opposite direction. Their commitment to the NHS must be increased if we are to avoid recurring inequalities in access to dental care.

Helen Goodman: The hon. Gentleman has repeatedly mentioned inequalities. He is probably not aware that last week, in my constituency's most deprived ward of Coundon, a new health centre was opened with provision for two dental chairs, where there has never been a dentist before. His point is not borne out across the country as a whole.

Andrew Lansley: I received an e-mail from a dentist in north-west London—I think that he was in the constituency of the right hon. Member for Holborn and St. Pancras (Frank Dobson)—who was abandoning NHS dentistry and was deeply depressed about the Government's implementing of the new contracts. I am afraid that wherever one goes, including in north London, there are dentists who are going to do that. This morning the Minister and I discussed on the radio what is happening in Barnsley. I do not know whether any Members from Barnsley are here. That is not a wealthy area, but patients there have been queuing for private dentistry because their dentist has abandoned the NHS.
	It is time for a new system. We know where the Government are heading because the Minister has made it perfectly clear in previous discussions. She is threatening dentists by saying that if they do not choose to do NHS work, she will find other dentists who will. There will be dentists coming in from Poland.

Stewart Jackson: Perhaps, like me, my hon. Friend would like to disabuse the hon. Member for Bishop Auckland (Helen Goodman) of the notion that everything is rosy in NHS dentistry. In my constituency, 34,000 patients have been deregistered, with a huge impact on lower income groups, older people and young families. What is worse is that the primary care trust has been forced into political posturing by operating a hotline that patients have to phone secretly to be told where the new NHS registrations are. That is spin under the NHS.

Andrew Lansley: As my constituency is nearby, I have seen that that is indeed what is happening in my hon. Friend's constituency, where the enormous loss of NHS dentistry is affecting a large proportion of his constituents. I sympathise with him and agree with the support that he is giving to NHS dentistry in his constituency.

Michael Penning: It is not only certain constituencies that are in crisis, but the whole country. When the Select Committee on Health looked into this, the Minister eventually admitted that 30 million people in this country do not have an NHS dentist.

Andrew Lansley: That is right. Only about 40 per cent. of non-exempt adults have access to NHS dentistry. Of course, the Government are going to abolish registration and manipulate the figures. They will say that increased numbers of people see an NHS dentist, but that does not mean that they are necessarily registered with them or have access as they did in the past on the basis of a long-term relationship.
	It is deeply worrying that fewer children are getting access to NHS dentistry. This morning's Which? report said that 82 per cent. of the public think it extremely important that children get free dental treatment, but that too is being lost. The inequalities are dramatic. In some places, a quarter of adults have access to NHS dentistry, while in other places it is 60 per cent. That is deeply unacceptable in a national health service.
	The Minister always used to say that we need a new way of working; well, we do. We need a new way of working that is not about dentists on a treadmill, particularly a new treadmill that is governed by primary care trusts, which, as the National Audit Office made clear, have none of the expertise necessary to put this new system in place. We cannot move towards the system that the Government seem to be proposing whereby patients have perverse incentives to delay treatment or present as urgent cases with pain because it will be cheaper than if they have the work done while not being in pain. We must have a system whereby the patient's relationship with their dentist is geared around preventive work and good oral health, patients know that they have security of access to NHS dentistry, and dentists are incentivised to offer NHS dentistry and to increase their commitment to NHS dentistry instead of reducing it.

John Hemming: The hon. Gentleman almost certainly knows that the deadline for the first return of contracts was yesterday. If people have not returned their contracts by yesterday, payments will be delayed by a month. The secretary of the Birmingham dental committee told me that 75 per cent. of NHS dentists had not returned their contracts by the deadline. Some may be returned this month but the figures show a massive reduction in the number of NHS dentists in Birmingham.

Andrew Lansley: I understand the hon. Gentleman's point. We held discussions with the Birmingham dental committee, as he doubtless has. Dentists in Birmingham are rightly anxious and angry.

Richard Burden: Will the hon. Gentleman give way?

Andrew Lansley: No.
	As I explained, we need a new way of working. However, we have made it clear that it is most important not only to commit ourselves to improving the NHSoverall but to trusting NHS professionals. Happily, in this instance, the desires of the patients and the profession are exactly the same. Patients want a relationship with a dentist in which they have security of access and certainty that what is in their interests—good oral health—is being pursued, with their making a reasonable rather than an excessive contribution through charges. That is what we need. The motion calls for that, even at the last minute.
	Two weeks ago, the Minister met representatives of the British Dental Association, who left the meeting deeply disappointed with its results. It is not too late for the Government to withdraw the contract, suspend the use of units of dental activity and work through a piloted system that is based on capitation. That is the way forward. I urge the Government to do that even now, and I urge the House to support the motion.

Rosie Winterton: I beg to move, To leave out from "House" to the end of the Question, and to add instead thereof:
	"welcomes the Government's Oral Health Plan for England, which builds on major oral health improvements in the last 30 years, and the additional £368 million for improving dental services in England announced in July 2004; recognises the Government's substantial achievements in improving the short and longer term supply of dentists for the NHS including recruiting the equivalent of an extra 1,459 whole-time dentists between April 2004 and October 2005, compared to the 1,000 extra dentists promised, and funding an additional 170 training places; further recognises that the Government is investing £80 million in improving dental school facilities, and has approved the establishment of a new dental school in the South West Peninsula; notes that the total number of primary care dentists in the NHS had increased to more than 21,000 by the end of October 2005, compared with 16,700 in 1997; further welcomes the reduction in the maximum patient charge from £384 to £189 from 1st April; further welcomes the new ways of working tested through Personal Dental Services pilots; supports the framework for new dental contracts which will free up significantly more time to provide preventative care, remove the requirement for NHS dentists to treat patients on a fee for service basis and ensure that a committed NHS dentist can expect to earn on average around £80,000 a year; and further welcomes the fact that, where dentists do not take up new contracts, primary care trusts will commission replacement services from other dentists."
	Although the motion is flawed, it gives us the opportunity to debate NHS dentistry as we approach the implementation of the most significant reforms to dental services in the history of the NHS. It is worth reminding the House why we are making those changes to NHS dentistry. The current system provides no real stability for patients or the NHS. Under the traditional general dental services system, dentists can set up in practice where and when they wish and decide how much or how little NHS dentistry they wish to undertake. There have traditionally been no local budgets for dentistry. When dentists decide to reduce or abandon their NHS work, the NHS locally has no power to commission replacement services. I know that that has affected hon. Members of all parties and caused immense problems. That volatile system has not served patients well.
	On top of that, the contract under which dentists have worked has been extremely unpopular with them, especially following changes that were introduced in the 1990s and the subsequent fee cuts. Let me remind hon. Members that the traditional way of paying dentists is based on payments for 400 individual items of service, for example, a filling, a crown or having a tooth out. That put the emphasis on invasive work rather than preventive treatment. As hon. Members have said in the House previously, it has been confusing for patients, who often did not understand what they were paying for on the NHS and what they were paying for privately. I am sure that many hon. Members have experienced constituents saying, "I've just paid £1,000 for treatment on the NHS." When they have come to me, I have told them that they could not have paid that amount because the maximum that they can currently pay on the NHS is £384. However, confusion between NHS and private treatment has occurred.
	The dental profession, especially the British Dental Association, complained for many years about the treadmill effect of how dentists were paid. As I said, that put the emphasis on invasive rather than preventive treatment and was an incredibly bureaucratic system for dentists. Two dental schools were closed under the previous Administration. Again, that significantly reduced the numbers of dentists in training.
	To tackle the genuine shortages in access to NHS dentistry, we have taken some immediate action.

Mark Francois: I want to speak about clinical dental technicians, who specialise in making dentures, especially for senior citizens. The Minister knows that they are subject to a regulatory review by the General Dental Council and that they want to be brought within a new regulatory framework to remove the anomalous situation under which they have operated for many years. They have two key requests. First, they want a reasonable transition period. Secondly, if retraining must occur, they ask whether it can take place on a part-time basis in the United Kingdom to allow them to retrain in a way that does not destroy their livelihood. Does the Minister agree that that is reasonable and will she make that point to the GDC?

Rosie Winterton: I hope that the hon. Gentleman understands that the GDC makes its own rules about what it considers to be appropriate training and registration requirements. However, he is right to point out that there are many opportunities under the new system not only for dental technicians but for dental therapists and hygienists. As we change the way in which dentistry is provided, we can increasingly make better use of different skills in the dental team. I believe that, when we consider the role of dental nurses and hygienists in future, they can increasingly take on some of the minor work that dentists currently do, leaving dentists to do the more complex work. However, I shall consider the hon. Gentleman's points and I am sure that the GDC will be aware of his comments.

Steve Webb: The Minister was about to consider access. Will she clarify a point about the position after 1 April? Will two people who live next door to each other, one registered with an NHS dentist and the other not, have different rights of access to NHS dentistry after 1 April? Does being on an NHS dentist's list now grant more rights than not being on such a list?

Rosie Winterton: The person who is currently registered with an NHS dentist will remain attached to that dentist on a dental list. That is not the same as registration because people currently fall off the register. We want to stop that because it has caused difficulties in the past. However, the person who is currently registered will remain attached to his dentist. I hope that the changes that we are introducing will free capacity and that the person next door who is not registered with a dentist can get registered. We are aiming for that. That is why it is so important that primary care trusts have the power to commission locally, examine the needs of their population and commission accordingly.
	Since 1999, we have set up 53 dental access centres in areas where there was a clear shortage of NHS dentists. Those centres mostly provide urgent treatment but some provide routine treatment. Compared with 2003, we are now investing an extra £250 million every year in NHS dentistry, with a further £65 million to follow next year. We have recruited the equivalent of more than 1,400 whole-time dentists to work in areas with the greatest access challenges.
	I am sorry that the hon. Member for South Cambridgeshire (Mr. Lansley) chose to denigrate the contribution of Polish dentists. In many areas of the country, they do an excellent job. In areas of particular shortage, we have been able to assist the position through careful international recruitment and carefully passing people on to those areas. I am sure that many Conservative Members are grateful for their contribution.

Daniel Kawczynski: rose—

Rosie Winterton: In the circumstances, I feel that I must give way to the hon. Gentleman.

Daniel Kawczynski: I am pleased that the Minister has acknowledged in the Chamber the tremendous work that Polish dentists do in the United Kingdom. Almost all the new dentists in Shrewsbury have come from Poland. I speak to many Polish NHS dentists in their mother tongue and they tell me that they will return to Poland after a couple of years. That is a tremendous problem.

Mr. Deputy Speaker: Order. I hope that the hon. Member will not spoil the moment by making a speech. Perhaps he could ask a final question.

Daniel Kawczynski: Will the Minister look into the difficulty caused by those Polish dentists being here on only a short-term basis?

Rosie Winterton: I hope that I shall be able to reassure the hon. Gentleman later in my speech that there are dentists coming from all different quarters. NHS dentists are now offering to do more NHS work, and others are coming in through the international qualifying examination. Some of them may well wish to stay for only a short time, and that can be helpful in that they take different skills back to other parts of the European Union. I do not have a problem with that; it does not mean that we are going to experience a shortage. Indeed, in some ways, quite the opposite is the case.

Linda Gilroy: When I was out on a Saturday morning recently knocking on doors, as we do at the weekends, I met a Swedish dentist who thanked us for helping with his planning permission. May I thank the Minister for the £28.4 million investment that has been made in Plymouth, and ask her how soon she expects the new dentists to come on stream following that extra investment in dental training?

Rosie Winterton: Obviously it takes some time to train a dentist. We have recruited extra dentists over the past year, as well as announcing 170 more dental training places from September last year. In January, I announced the creation of a new dental training school in the south-west of England, and I suspect that that is what my hon. Friend was referring to. I was pleased that a good bid was put in by her area, and that we were able to make that announcement.

Eric Martlew: Does the Minister agree that the reason why we can recruit dentists from all over Europe is that even those dentists who work for the NHS are among the highest paid in Europe?

Rosie Winterton: My hon. Friend is absolutely right. I believe that 12 new dentists have been recruited to his area recently. A dentist with a fairly high commitment to the NHS can expect to earn about £80,000 a year, with practice expenses on top of that. That is not a bad deal.

Andrew Turner: I am grateful to the Minister for working to bring 14 new dentists to my constituency. However, even with those new dentists, registrations have gone down since she came to the Isle of Wight. In two years' time, when the 24,000 people who have asked to register with those new dentists have done so, about 50,000 people in my constituency will still not be registered with an NHS dentist. Is that satisfactory?

Rosie Winterton: As the hon. Gentleman said, I have visited his constituency. I know that there were considerable problems there, and I am glad that we have been able to assist him. His was one of the first areas that our support team went into to help with recruitment. I do not think that there were any NHS dentists there before that, but we managed to recruit eight into the area. I shall explain later how, under the present system, there will be room for extra capacity as the changes bed in, as well as the ability to have funding at local level to commission NHS dentistry if there are needs in the local area.
	I want to explain how we are introducing a radical shake-up in regard to how NHS dentistry will be delivered in the long term. To go back to the basics of the plan, from April this year, primary care trusts will for the first time be able to commission and develop primary dental care services in ways that reflect the needs of their local populations. For the first time, they will have the financial power to commission new services when a dentist leaves the area or reduces their NHS commitment. That was one of the problems in the hon. Gentleman's constituency. For the first time, we will have a system of dental charges that is simple and transparent for patients, and a remuneration system that no longer encourages the drill and fill treadmill.
	The new contract that we are offering to dentists will mean that a committed NHS dentist can expect to earn about £80,000 a year, with practice expenses on top of that. That £80,000 will be guaranteed for three years, for 5 per cent. less work. In return, dentists will be expected to carry out an agreed number of courses of treatment over the year—again, at least 5 per cent. below the levels in the old contract.

John Penrose: I am sure that dentists will be pleased to hear those figures. However, will the Minister explain how the technical application of the new contract has led to the situation in my constituency about which I wrote to the Secretary of State on 19 January? The single major NHS dentist in the area, whose practice covers 22,000 people, expects to lose 30 per cent. of those patients—that is, 6,500 people—as of 5 April, as a result of incorrect base-lining and problems with the calculations. I wrote to the Secretary of State about this on 19 January, and the clock is ticking. That dentist needs an answer.

Rosie Winterton: The way in which the contracts were calculated involved a reference period that ran from October 2004 to September 2005. During that time, the activity of the dentists was measured, along with the amount that they were paid during the period. The calculation should reflect those two figures, and produce the amount that the dentist would be offered, which would be guaranteed for three years. If a dentist has a problem with the calculation, they should pursue the dispute resolution procedure. However, the primary care trust might be able to identify the reason for the problem—the dentist might have taken on an associate during the year, for example. It is difficult for me to comment on individual cases, but there is a dispute resolution procedure to deal with problems with the amount in the contract.

James Gray: Is there not a problem for practices such as the Caledonia practice in my constituency, which is expanding fast and has taken on two dentists since the end of the base-line period last September, but is now having to lay off those dentists because it cannot afford to pay them, given the amount that it is being offered? Will the Minister also confirm that a PCT is required by law to use any funds made available through the closure of a dental practice for dentistry and for no other purpose?

Rosie Winterton: Yes, I will. The way in which the budgets have been given out is quite complicated, but I will try to explain it. During the reference period that I mentioned, an overall measurement was taken of the activity in a particular area. It is possible that, during that time, certain dentists might have worked for only half the year, because they had started up half-way through the reference period. Others might have closed during the period. The calculation took into account the balance between those that had opened and those that had closed, so that a dental practice that had opened half-way through the year would be able to use the money that had become available from one that had closed. So that would have added up. If, however, it did not add up in that way, extra money would be allocated, but it would not be able to meet every local circumstance. The instance that the hon. Gentleman has cited involves a dental practice expanding after the reference period. We had to have a cut-off point—[Hon. Members: "Why?"] Otherwise, it would not have been fair in terms of allocating the funds. The PCTs wanted to know the size of their budgets. We had that reference period so that we could make that calculation. On top of that I should say that £65 million has gone out to PCTs to ensure that there can be expansion. That is the difficulty that the hon. Gentleman might be facing. However, I should also say in relation to 31 March that the PCT will retain all its money locally. If there are dentists who decide that they do not want to stay with the NHS, the PCT will have the absolute right to go back to dentists such as those the hon. Gentleman has mentioned to say, "This is how we can replace the NHS dentistry that may have been lost." I am sorry if that is a rather long and complicated explanation, but that is basically how things work.

Several hon. Members: rose—

Rosie Winterton: May I move on? I am conscious that we are getting towards the time when Back-Bench Members will want to contribute.
	Today's debate has shown that concerns have been voiced by some dentists about the changes, but that is not altogether surprising, because they are quite radical. New ways of working have proved popular in the personal dental services pilots, which cover some 30 per cent. of dentists.
	To return to a point made by the hon. Member for South Cambridgeshire about a system of payment per head for those registered, we considered that suggestion during the piloting and found a lot of problems, not least because in some areas the number of treatments carried out fell by about 50 per cent., but without an equivalent increase in the number of people seen. Such a system also has a bias towards people with good oral health who would be taken on under it.
	I quite understand why the hon. Gentleman is making that suggestion and I am more than happy to send him the data—[Interruption.] If he wants to intervene, I am perfectly happy to give way.

Andrew Lansley: The National Audit Office report was very clear. Yes, there was a reduction in the number of treatments, because the drill-and-fill system had an incentive to overtreat. Of course the number of treatments reduced. We have to measure outcomes—that is what we should be doing—and the NAO was clear about the fact that the 10 per cent. reduction in treatments, on average, was none the less associated with no deterioration in the oral health of people on those patient lists.

Rosie Winterton: But that is not the point about the system that the hon. Gentleman is suggesting. He is suggesting that each dentist be paid per patient. The difficulty with that, as I have said, is that we tried it in the pilot schemes and it effectively contained a bias towards taking on people with good oral health as opposed to those with a variety of types of oral health. I am perfectly happy to send him the data from those pilots so that he can look at them. All I am saying is that I can assure him that we considered and piloted that suggestion, but the evidence that came back suggested that it is not the right system.

Several hon. Members: rose—

Rosie Winterton: I give way to the right hon. Member for Wokingham (Mr. Redwood).

John Redwood: Can the Minister explain why we do not have enough NHS dentists? Is it something to do with the extremely elaborate remuneration method, which seems to be freezing the system in aspic when we need a dynamic system that allows growth for new dentists?

Rosie Winterton: That is quite astonishing, coming from the right hon. Gentleman. We have a lot of these problems—this is very well recognised—because of the contract changes and fee cuts made in the 1990s, as well as the closure of two dental schools. We are turning round the system that we inherited and introducing some changes.

Several hon. Members: rose—

Rosie Winterton: I shall move on, because I want to make some remarks that I hope will help the House.
	As I have said, I know that, for some dentists, the changes are a fundamental shift from the traditional way of working. Understandably, they are quite nervous about that, so I have decided to set up an implementation group with representation from the profession, patients and the NHS to review the impact of the reforms and ensure that they are delivering their intended benefits, for patients and for dentists. I have invited representatives from the British Dental Association to join the group, and I hope that that is a way to reassure dentists that we are looking closely at the implementation of the reforms and ensuring that if any adjustments need to be made, they can be.

David Drew: Will my hon. Friend include orthodontists in the group? As has been mentioned, there seem to be specific problems with how the lists will be compiled for orthodontists. It is only fair that those valuable servants be included.

Rosie Winterton: I will certainly consider the point my hon. Friend raises, particularly perhaps with reference to the British Orthodontic Society, which we have been in discussions with recently. He is right to say that there have been problems with orthodontics, because obviously such services are offered over a number of years. If new practices have been set up, which we have been able to do because of the increased investment that we have put in, they might have had a short contract value during the reference period. Recently, we have again issued guidance to PCTs including principles such as current treatment having to be completed. They need to look at orthodontic requirements locally and ensure that there is proper commissioning. I acknowledge that this has been a problem, but we have tried to clarify it.

Several hon. Members: rose—

Rosie Winterton: If I may, I shall move on, because it is important to say that we will not know until the end of this month precisely how many dentists are taking up the new contracts. However, the current view from PCTs is that the vast majority of contracts will be signed by 31 March.
	I should stress that, in the minority of cases where dentists choose not to take up the new contracts, the NHS will use the same funding to commission replacement services from other dentists. I am extremely confident that the NHS will generally be able to bring in new capacity very quickly. In the small number of cases where people say that they no longer want to remain with the NHS, we are finding that other dentists are coming forward to say that they want to expand their NHS provision.

Andrew Lansley: Would the Minister like to tell us whether this alternative commissioning will be like the dental access centres? The average cost per patient episode, according to the Government's own figures, is £141 compared with £41 for high street dentists.

Rosie Winterton: I am not sure that the hon. Gentleman has quite understood exactly how the new commissioning will take place. If a dentist chooses to leave the NHS, that money can be used by the PCT to provide what it feels is appropriate in the local area. If it feels it is appropriate to have a dental access centre, it can have one. However, it is more likely to want to commission dentistry from the existing dentists in the area.

Several hon. Members: rose—

Rosie Winterton: I shall give way to the hon. Member for Congleton (Ann Winterton), then I shall finish my remarks.

Ann Winterton: I rather suspect that the name has something to do with the Minister's giving way. Will she estimate the number of new dentists who will be appointed? How many of those will be directly employed by the NHS and not work for traditional NHS practices? As my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) said a moment ago, the cost of providing treatment in that way is about twice the normal cost at present.

Rosie Winterton: May I explain? Most dentists are independent contractors anyway. They are paid by the NHS. Some have greater commitments to the NHS than others, but there are no private NHS dentists, as it were. At the same time, some dental access centres often provide emergency treatment, which we would necessarily expect to be more expensive, and do not always charge fees as well.
	We would expect there to be a range of providers who might want to come in. It would be for the PCT to decide which kind of provider it wanted to use, whether a direct one, one through the salaried service, or an independent contractor in the normal way. As I have said, large numbers of NHS dentists are keen to expand their commitment. We know that, because that is what local PCT dental representatives have been telling us. Something like 1,000 overseas dentists are currently sitting the international qualifying examination, and a number of dental corporate bodies, which have a track record in areas such as the constituency of my hon. Friend the Member for Carlisle (Mr. Martlew) in Cumbria, have expressed an interest in establishing new practices, and are already taking up new NHS contracts.

Roger Gale: The East Kent Coastal primary care trust has repeated the Minister's mantra that money "saved" by dentists leaving the national health service will be used to buy other dentists. The fact is that those other dentists do not exist. Existing dentists' lists are already full and have a backlog. Dentists in east Kent are closing or leaving the NHS. There is a gap, and children in particular are waiting for dentists. Where will those dentists come from?

Rosie Winterton: I think that I just explained what the PCT is entitled to do, and probably will do, if there are not dentists in the area. For example, dental corporate bodies are keen to establish NHS dentistry, making use of some of the 1,000 dentists currently sitting the international qualifying examination. The hon. Gentleman must recognise that the money remains at local level so that the PCT can commission dentistry. There is no reason why it would not be able to do so. It has happened in other parts of the country, and I am confident that it could happen in his area, too.

Nick Hurd: rose—

Rosie Winterton: I have explained how budgets were to be spent. The budgets that will be devolved to PCTs next year are around £315 million more than in 2003–04. As I have said, all existing NHS dentists are guaranteed contract values based on their NHS earnings during the reference period.
	I also want to set the record straight with regard to two other misapprehensions about the reforms.

Paul Rowen: rose—

Rosie Winterton: First, I am afraid that the British Dental Association, among others, has persisted in alleging that the reforms do not promote preventive dentistry. That goes against the clear evidence from personal dental services pilots showing that abolishing the fee-per-item system enables dentists to carry out simpler courses of treatment, with far fewer interventions and far more time to focus on preventive care.
	Secondly, the new system of patient charges has been based on the recommendations of a working group chaired by Harry Cayton, National Director for Patients and the Public, including representatives from the British Dental Association among other stakeholders. The working group unanimously recommended a system based on three simple charge bands. At present, there are more than 400 separate charges for different items of treatment. [Interruption.]

Mr. Deputy Speaker: Order. If Opposition Front Benchers want to intervene, they ought to do so in the normal way.

Andrew Lansley: Will the Minister give way?

Rosie Winterton: Of course.

Andrew Lansley: I am grateful to the Minister. Will she therefore explain why the Cayton review recommended £11 for band 1, and she has £15.50; £27.50 for band 2, and she has £42.40; and £127.50 for band 3, and she has £189?

Rosie Winterton: It is because the recommendations of the Cayton review on cost per band were meant to reflect the patient charges that would be raised during the time that it was produced—around January 2004, I think. Obviously, when we published it, we had to take into account the increased expenditure on NHS dentistry, and we wanted to raise the same amount in proportion in terms of NHS dentistry. The hon. Gentleman fails to mention over and over again that the maximum that can now be paid for NHS dentistry has been cut from £384 to £189, which particularly affects older and poorer people.

Stephen McCabe: Surely there is something less than sincere about the position of the hon. Member for South Cambridgeshire (Mr. Lansley). He talks about his concern for NHS charges, but earlier today was happy to support unscrupulous dentists who are exploiting elderly, vulnerable people. Where is the consistency?

Rosie Winterton: Consistency has not been a hallmark of the contribution from the hon. Member for South Cambridgeshire today. As I have said, the new system makes it much easier for patients to distinguish between what they are paying for under the NHS and what they are paying for privately.
	I want to finish by reminding the House of the broader objectives to which the reforms are designed to contribute. We want to support further improvements in oral health and reduce inequalities in oral health. We want to promote high-quality dentistry throughout the NHS. We want to improve access to services for NHS patients. I agree that the full benefits will not arise immediately.

Mark Pritchard: Will the Minister confirm that her Department will allow primary care trusts the freedom to procure dental health services from anywhere in England if, for instance, my constituents were waiting an intolerable amount of time?

Rosie Winterton: I want the hon. Gentleman's primary care trust to ensure that there is appropriate provision locally. We can help support primary care trusts by providing them with extra money, which we have done, and a contract worked out with dentists that reduces bureaucracy and allows better care for patients, which we have done; and through measures such as the international qualifying exam to ensure that NHS dentistry can be provided locally The improvements in access will rely in part on the growing use that primary care trusts make of their new flexibilities under local commissioning. They will also rely on dentists adapting to new ways of working, which free up time, as we have seen from the pilots, and increase capacity to enable a greater number of patients to be seen.

Nick Hurd: A specific concern of dentists in my constituency is that devolved budgets appear to be ring-fenced for only three years. Hillingdon PCT is wrestling with a deficit of £25 million, and dentists are concerned that in time funds will simply be siphoned off from dentistry into other medical priorities. Does the Minister understand those concerns, and what reassurance can she give?

Rosie Winterton: I am sure that the hon. Gentleman is pleased that there is ring-fencing for three years. Beyond that, I cannot predict or give guarantees. We have, however, ensured the ability to ring-fence, and introduced a duty on PCTs to provide dentistry to meet local needs. I hope that that is some reassurance.
	I hope that right hon. and hon. Members will recognise the scale of what we have achieved, both in growing the dental work force and tackling some deep-rooted access problems. I hope that the House will welcome the reforms as providing a hugely more secure basis on which the NHS can build on improvements, working in partnership with patients and members of the dental profession. It would be irresponsible to halt the changes as the Opposition motion suggests. It would cause immense confusion to dentists, patients and the NHS, and take us right back to the bureaucratic drill-and-fill treadmill so disliked by the dental profession. The Opposition have offered no new ideas, only carping at the sidelines. I urge the House to reject their motion and to support the Government amendment.

Julia Goldsworthy: D-day for NHS dental patients is rapidly approaching. The new financial year will bring many changes to dentistry—a new contract, new charges, and a new way of measuring dental activity—but the key question is, are patients really aware of the bombshell that could drop on them in the new financial year? For them, D-day will be deregistration day. On 1 April NHS dentists will be subject to the new contract, but how many dentists will decide that because of it, the NHS is no longer for them? How many patients will find themselves deregistered, with a choice between paying for the same dentist and taking a gamble, and trying to find another NHS dentist with vacancies on his list? Has the Minister or her Department made any estimate of the number of dentists who will refuse to sign a contract that the British Dental Association has called, among other things, "a shambles", given that yesterday was the last day on which NHS dentists could sign and guarantee payment on time?
	How many dentists does the Minister estimate will not have signed the new contract by the deadline at the end of this month? How many does she believe will sign the contract, but at the same time formally enter into dispute proceedings? The Minister talks of "the vast majority", but a more specific figure would be appreciated.
	In addition to their initial contract agreement, 75 per cent. of dentists in the constituency of my hon. Friend the Member for Birmingham, Yardley (John Hemming) have signed a letter stating:
	"We wish to clarify that the figures referred to in that memorandum are not accepted as being a definitive correct representation of our earnings . . . in relation to the provision of NHS dental care . . . and that they represent only a provisional representation of our earnings and activity. For the avoidance of doubt, we reserve our right to initiate the statutory dispute procedures in respect of either the figures provided, or the basis on which those figures have been calculated."
	How many dentists does the Minister estimate will enter into dispute proceedings at the same time as signing the initial agreement?

Paul Rowen: Is my hon. Friend aware that in Heywood and Middleton, the constituency next to mine, every dental practice is refusing to sign the contract? That will leave Heywood and Middleton with no NHS dentists, which is already virtually the case in Rochdale.

Julia Goldsworthy: The position is similar in many parts of the country.

Linda Gilroy: The hon. Lady represents an area with some of the lowest wages in the United Kingdom. Does she not think her constituents will find it a little strange that she appears to support the position of people who consider £80,000 a year to be an income not worth working very hard for?

Julia Goldsworthy: I am sure that patients of NHS dentists will be more interested in the fact that the cost of check-ups and band 2 treatments will increase, and the fact that they may not be able to find an NHS dentist at all.
	For 9,000 patients in my constituency, D-day—deregistration day—has already arrived. Last week, one of the biggest NHS dental surgeries in the constituency announced that its 9,000 adult NHS patients would either have to go elsewhere for NHS treatment, or have one week in which to decide whether to sign up for a direct debit plan and private treatment.

John Redwood: Will the hon. Lady tell us what is the Liberal Democrat plan for recruiting more dentists, and how much it would cost?

Julia Goldsworthy: We would of course continue to negotiate the contract, which the British Dental Association has clearly rejected but which the Government seem to be pushing relentlessly, although it appears that many dentists will not sign it. According to the Minister, the vast majority may be signing. That could mean thousands of patients per dentist being denied access to NHS treatment.
	The dental surgery that I mentioned has three dentists. They gave their reasons for withdrawing from the NHS, which were very specific. They said that
	"a new NHS system is being proposed by the government and we have been unable to negotiate terms that we feel are in the best interests of our adult patients. We will therefore not be able to treat patients in the NHS from 1 April 2006."
	My constituents who are affected are understandably shocked, and do not know what to do next. I have been inundated with correspondence from them, asking what they should do. For many, the choices are stark. One wrote:
	"Can't afford the monthly fee offered—and this doesn't cover anything I need anyway".
	Another wrote:
	"We are shocked that we had no previous knowledge and had not been consulted about this closure, and we are being forced into signing up within a week to a costly private scheme or losing all further treatment".
	Those people do not feel that there will suddenly be a magic alternative.

Eric Martlew: Will the hon. Lady condemn the dentists who have caused so much suffering to her constituents?

Julia Goldsworthy: Many of the dentists to whom I have spoken feel that they cannot offer their patients the level of service that they deserve under the current contract.
	All over the country, as other Members have said, thousands of NHS patients are hearing similar bad news. Many of them do not realise that the Government's policy is creating the problem, at a time when NHS dentistry is already in crisis. Another of my constituents wrote:
	"We do not know about the new government proposals mentioned in their letter that they are using as an excuse".
	They clearly have not had time to read the new leaflet explaining the changes.
	Ultimately, however, the patients do not care what is causing the problem. They may not know that dentistry's woes started with the Conservative Government's creation of the drill-and-fill treadmill, and the closure of two dental schools. They may not know that the breakdown in negotiations over the new contract has proved to be the final straw for many dentists. All they know is that they face losing their NHS provision, and it is not clear how they will find an affordable alternative.

Alison Seabeck: Will the hon. Lady at least acknowledge that the new dental school that is coming to Plymouth will provide new dentists not only in Plymouth but in the wider south-west, including Cornwall?

Julia Goldsworthy: In five years' time, once it is up and running, the dental school will provide new dentists, but there is no guarantee that they will enter the NHS. Moreover, if the current funding is based on levels of activity, there will be no vacancies for them in Cornwall even if they want to enter the NHS.

Linda Gilroy: Will the hon. Lady give way?

Julia Goldsworthy: I am afraid I must make some progress.
	Yet another horde of dentists look set to abandon the NHS, as they did in the early 1990s. The only difference is that a different political party is in power. The new contract does not mean more dentists for the NHS. Primary care trusts may have access to funds for alternative NHS dental surgery provision when existing dentists leave the NHS, but how does the Minister estimate that PCTs will be able to recruit enough dentists to fill the vacancies? In Cornwall 9,000 patients are being deregistered, while 14,000 are being deregistered in Cheltenham. How will those vacancies be filled? Where is the capacity for all the dentists who are so desperate to sign the new contract? Stockton-on-Tees already has eight vacancies. If more dentists refuse to sign the contract, the number of vacancies will increase.
	The new contract does not automatically mean that more people will be treated in the NHS, because it is based on the existing number of dentists and their budgets. No assessment or investment has been made with a view to meeting previously unmet demand, and it is not clear how the Government will fulfil their 1999 pledge to give everyone access to an NHS dentist. That means that even in my constituency, which ought to benefit from a dental school, more cannot be spent on a net increase in the number of dentists or in NHS provision unless the Government are prepared to ensure that extra funds are available, and unless more dentists feel that the NHS offers a contract that is attractive to them.
	There are plenty of new circumstances, but there is no improvement in the current dire situation. Millions of people are not registered with a dentist at all, and three quarters of those who are not registered with an NHS dentist say that they wish they were. Demand continues to outstrip supply by a significant amount, and the new contract will not change that fundamentally. The contract will also fail to provide patients who are lucky enough to receive treatment with better standards of treatment, and a stronger focus on preventive work.
	The personal dental services pilot was popular because it allowed dentists to spend more time with their patients, and to focus on preventive advice as much as on treatment. It ended the drill-and-fill treadmill. Most of the dentists who are refusing to sign the new contract took part in the pilot, although it has been much vaunted as a reason for the contract. They feel that flexibility has been lost in the new general dental services contract because a new treadmill has been introduced: units of dental activity. It is another target-driven system that does not appear to be well understood on the ground either by dentists or primary care trusts, and it is essentially untested. It was not in the initial pilot.

Rosie Winterton: Does the hon. Lady accept that we should be able to monitor and measure dental activity, given the amount that we spend on it locally? How would she monitor dental activity?

Julia Goldsworthy: I would like the Department to monitor dentists on a full-time equivalent basis, rather than on a head-count basis. I have used this example before: I have spoken to a dentist who is on the NHS list and who has three NHS patients—his wife and two children.

Paul Holmes: Does my hon. Friend agree that the Minister's speech was strong on wishful thinking and weak on reality? The reality for my constituents in Chesterfield is that the wonderful new contract has driven dentists to leave the NHS. In recent weeks, a wave of my constituents have come to me to say that they have been given the choice between taking out expensive private medical insurance and looking for another dentist. However, when they look for another dentist, it is almost impossible to find any slack in the system that enables new NHS patients to be taken on.

Julia Goldsworthy: That has been the experience in many other places. Of course, it is outcomes that are most important, rather than the treadmill of units of dental activity.
	As we have heard, local dental committees report real concerns about the test year. The new UDA targets are based on the test year, but do not account for variances during the year, which could result in contract values that do not represent the NHS work that is undertaken. The system has not been piloted. I am pleased to hear that a review is to be conducted, but what will the Government do to implement the review group's recommendations? When will it be set up? Will it be in time for the introduction of the new contract on 1 April?
	Will we know whether more patients are accessing NHS treatment if it is courses of treatment, rather than registrations, that will be measured? What will happen to waiting lists at NHS dentists if people stay on the register permanently? Will we see a massive increase in registrations, with many patients struggling to get a check-up on the NHS within two, three or four years? Will there be any measurement of how long the average time is between check-ups for the average patient?

Rosie Winterton: Will the hon. Lady give way?

Julia Goldsworthy: I will if the Minister will allow me to make some progress.
	If that means that people will go longer between check-ups, how can that be squared with the Government's stated aim to shift their focus to preventive work? Under the new system, people will go to a dentist only if there is a problem.

Rosie Winterton: Again, I do not think that the hon. Lady quite understands the system. The NICE guidelines have changed. It is up to the dentist to decide when a patient should come back. Some patients will have to come back within six months, but the point about the flexibility in the new way of working is that, if the dentist believes that the patient has good oral health and does not need to be seen for two years, that is when the patient would come back.

Julia Goldsworthy: Of course, if there are not enough dentists, how will those patients be able to access the regular check-ups that they need?
	That leads me on to the final changes, those to pricing structures—changes that, ultimately, the patients will notice. The price of a check-up will increase, surely deterring people from having regular check-ups, where not just caries but problems such as mouth cancers are detected, and where the preventive work that the Government claim is so important is performed.
	The new pricing structure means that the median price will increase, even though the charges for the most expensive treatments will reduce. According to the BDA, three quarters of the 42 per cent. of patients who fall into the middle band will end up paying more than they did previously. That will lead to perverse incentives, where problems will be stored up, so that the treatment is more affordable and represents better value for money for the patient. I have raised that issue with the Minister in previous debates and she has refused to accept it, but I quote one of my constituents to emphasise the point:
	"any problem that I have with my teeth I will now have to suffer as there is no way I can afford the charges."
	People are coming to me saying, "If I understand the new charging system correctly, it makes better sense for me to wait until I need two or three fillings and I can pay for them under one band, through one course of treatment, rather than having them one at a time, and paying three times for the same treatment."
	Primary care trusts are also concerned that the new charges and the new contracts will lead to even greater pressures being placed on emergency treatment centres. Previously, emergency treatment centres would accept only patients who were not registered with an NHS dentist. Now they will have to accept everyone. With emergency treatment cheaper than a band 2 course of treatment, there are concerns that people will wait until their problem is an emergency.
	It is also unclear how many and how well people understand what the new charging structures are and how they will be affected by them. I understand that the new information leaflets have been sent to primary care trusts and are sitting in NHS dental surgeries. Have the Government estimated the penetration of those leaflets and what the level of understanding is now about the new charges, given that they will be put in place on 1 April? Has the Minister's Department undertaken an evaluation report and, if so, will she be prepared to publish it? Will patients see the leaflet only when they go for a check-up? Will some patients know nothing about the new charging structure because they went for a check-up before Christmas and were told to come back in a year? They will not know that the price of their check-up will increase significantly the next time they go for a check-up. Does she think that that is fair and proper?

Rosie Winterton: I hope that the hon. Lady realises that, under the new system, it is not just an ordinary check-up that is undertaken. It is an examination, plus preventive health advice, plus a scale and polish if necessary, plus any diagnostics, for example, X-rays. That all comes within the £15 range.

Julia Goldsworthy: Of course, all the patients will know is that it is more expensive than last time. I would be interested to know how many leaflets have been produced, and how many have been sent to NHS and private dental surgeries, in case patients wish to switch to the NHS if they can. At what cost have they been produced? I understand that an evaluation report has been produced and I hope that the Minister will undertake to place it in the Library of the House.
	The theme that sadly emerges is one of a series of unknowns. A series of fundamental changes are being introduced but there has not been adequate testing and piloting to determine the changes' knock-on effects individually, let alone in combination. For those reasons, it is hardly surprising that patients, dentists and primary care trusts are still unclear about what the new contract will represent and what impact it will have. Since the Government did not spend the time in advance of the changes assessing their impact, I am glad to hear that a review group will be set up, but will the Minister undertake to implement its recommendations?
	The new contract and charging system has not produced the circumstances or incentives for patients to take a preventive approach to their health care. The cost of a basic check-up will increase, dentists will not have the time that they want to spend on preventive work, and it does not appear that more people will necessarily have access to NHS dentistry as a result of the changes. Ultimately, people will go for regular check-ups only if they can afford them, if they understand how the new system works, and if they can find an NHS dentist. It seems that many of the problems still remain essentially unresolved.

Eric Martlew: Before I get into my speech, I should like to thank all the hard-working dentists in my constituency and throughout the country who work well with the NHS. Sometimes, in my local skirmishes with some of my dentists, I have perhaps forgotten that.
	Did not the hon. Member for Falmouth and Camborne (Julia Goldsworthy) think it odd that the dentist whom she mentioned treated only his family on the NHS? Did she not think that that was a bit of sharp practice? Perhaps I am naive. Perhaps she can put his name on the record so we can all know who it is.
	I have sat and watched the Opposition—the major Opposition, because there is no one here from Lloyd George's party. One of the Conservative Members who attended the debate was a Minister in the previous Government and a practising dentist. The right hon. Member for Wokingham (Mr. Redwood) has just left, but he was in the Cabinet when the Conservative Government closed two dental schools. It is no good Conservative Members putting up their hands up and saying that that was 10 years ago. They did it and they also cut fees by 7 per cent. So do not imagine that dentists, even though they are angry with us, believe the Conservatives. They remember what being a dentist was like under the Conservatives. The haemorrhage of dentists away from the NHS started during their time in office, whether by accident or design; I leave Members to figure out which it was for themselves.
	There was a severe problem in Carlisle when four dental practices decided to resign from the NHS. They resigned before they saw the contract, so that was not their reason for doing so. The hon. Member for South Cambridgeshire (Mr. Lansley) mentioned people queuing to sign up for private treatment, and that did indeed happen at a particular practice in my constituency. The dentist in charge of it sent out a letter saying, "If you don't queue up and sign up, bringing your bank details with you, you won't be able to get a place." That resulted in hundreds of my constituents queuing from 5.30 in the morning, waiting to sign up. [Interruption.] If the hon. Member for South Cambridgeshire will contain himself, I will get to the point. That dentist was even handing out raffle tickets in another part of Cumbria. He said that he was going to cut the list, and that those who did not sign up early would be unable to get on it.
	A lady came to my constituency office on Friday and told me that she phoned that dentist four months later. The receptionist was over the moon that someone had actually phoned to ask whether they could sign up. In fact, the dentist had plenty of places left. Some dentists who have gone private will have a problem when—

Mark Pritchard: The hon. Gentleman and I share a concern about animal welfare issues, and I want to make the serious point that, unfortunately, because of these changes, it is easier for my constituents' pet dogs to get dental treatment in Shropshire than it is for my constituents to get such treatment.

Eric Martlew: I do not know about the situation in the hon. Gentleman's constituency, but the reality is that in most cases—leaving aside the valuable work done by the Royal Society for the Prevention of Cruelty to Animals—those of us who take our animals to the vet have to pay for such treatment. I presume that pets in the hon. Gentleman's constituency are not treated on the NHS; if they are, there should perhaps be an inquiry.
	The dental practice to which I was referring offered the caveat whereby the children of patients who signed up and set up a direct debit would be treated for free. That is an absolute disgrace. Unfortunately, neither the hon. Member for South Cambridgeshire nor the hon. Member for Falmouth and Camborne (Julia Goldsworthy) condemned such practice; hopefully, they can put that right during the wind-ups.
	Let us not be too concerned about dentists' earnings. Back Benchers are paid about £60,000 a year and most of us manage to live quite well on that. As the Minister said, an independent dentist with a good commitment to the NHS—and who probably does a little private work as well—earns in excess of £80,000 a year and gets a further £60,000 toward practice costs. A dentist who works for the NHS, but not as an independent contractor, could expect, after two years, to earn more than a Back-Bench MP—some £65,000—but with no practice costs. So dentists in my area, which is a low-wage area, are not badly paid.

Nadine Dorries: The hon. Gentleman is very lucky that only four dentists in his constituency are refusing to take on NHS work. The NHS Direct website has a list of all the dentists in Bedfordshire and, as of today, 20 of those 41 dentists are refusing to accept any new NHS patients for treatment; of the remaining 21, only 11 will register children. So many of my constituents will be unable to find NHS treatment.

Eric Martlew: The hon. Lady is obviously a very good MP but I am sure that she does not represent all of Bedfordshire. To compare my constituency to Bedfordshire is to compare apples and pears, which is what the Conservatives usually do.
	Let us look at why dentists are saying that they want to leave the NHS. They say that they do not understand the new contract and that they are concerned about the loss of independence, but the reality is that they realise that it is a question of supply and demand. They realise that they can make more in the private sector, and that they can probably work less hard for that money. Also—Members have yet to pick up on this point—they are being targeted by the insurance industry. They are being asked, "Don't you realise how much you could make if you use our particular plan?" Let us never forget that the insurance industry is the enemy of the NHS. Those who want to see where the big money in insurance is should go to America. We must treat with caution the private insurance companies working in this field.
	The dental reforms are welcome. An extra £360 million or more is being spent on improving dental services, and when a dentist leaves the NHS, the primary care trust in question will retain the relevant funding. At this point, I should congratulate my local PCT—Opposition Members have offered little thanks to PCTs—which has worked hard to ensure that people can access NHS dentistry. In particular, I congratulate the senior manager, Michael Smillie, on the tremendous work that he has done. Last week, we announced the provision of eight new dentists in Carlisle and Penrith. They will take on 20,000 patients and in doing so will probably clear the waiting list. Extra dentists will also be provided in Workington and Whitehaven—I note that my hon. Friend the Member for Copeland (Mr. Reed) is in his place—so we are tackling the problem. It will not be solved in a day, and I am not saying that all dentists are happy with the contract, but the vast majority are working with it and people will see the difference.
	The Minister has announced a new dental school—she kindly sent me a copy of the press release—for north Lancashire and Cumbria. That brand new facility, to be located at the Cumberland infirmary, will add to the excellent work already being done by its education centre. In training new dentists, it will thereby make up the shortfall. Be it dentists or doctors, the view is that, where they are trained is where they stay, so in four or five years' time we will have new dentists in our region. That said, I have no problem with dentists coming over from, for example, other parts of Europe. Patients tend not to have big conversations with their dentist.
	I congratulate the Minister on the points that she made about the contract and I am glad that she has decided to review it. The Conservatives failed dentists when they were last in power, and they have failed to cost their current proposals. I doubt whether the people of this country, even if they are concerned about dentistry, will turn to the Conservatives.

Several hon. Members: rose—

Mr. Deputy Speaker: Order. I remind the House that there is a 10-minute limit on Back-Bench speeches.

Paul Beresford: It is fairly well known that I have a slight interest in this subject. The Conservative Whips certainly know that, and they took the risk that I might not be entirely on message.
	I want to congratulate the Minister on two things. First, she has managed—almost, if not entirely, on her own—to upset just about every NHS dentist in general practice in the country. Secondly, the implementation group that she has set up sounds really positive. It is a mark of recognition, finally, that there are problems with the contract. Those problems may have more to do with perception, but they need to be looked at.
	Most general dental practitioners doing NHS dentistry or offering a mixture of NHS and private treatment want to continue to provide that service. Earlier, we got an inkling of the degree of willingness on the part of the Government in that respect, and that is what is needed to make progress. The hon. Member for Carlisle (Mr. Martlew) said that there were some sharp dentists out there, but that is true of every profession. However, they are a minority: most dentists are straightforward people who want to provide a mixed service because they have to face their patients, to whom it is virtually impossible to say no.
	I want to dodge most of the complaints usually raised in a debate such as this, and concentrate on a slightly different matter. The hon. Member for Carlisle spoke about what happened 10, 20 or 30 years ago, but there has been a dramatic change in the quality of dentistry on offer in this country. The teaching that dentists receive is vastly better, as is the quality of the materials that are available. Dentists are able to do much more for patients, but even more dramatic are the changes in what patients now demand. The things that people ask for are more the province of private dentistry than the NHS, and that means that dentists must be able to offer choice. That is the burden of my contribution, and it is something that I hope that the Minister will reflect on.
	In that connection, I want to touch on two matters—the treadmill, and mixed provision. The Minister said that the treadmill had disappeared these days. Like everyone else, I expect that she will have received a letter from Dr. Adrian Kinnear-King, in Norfolk. In his very bitter letter, Dr. Kinnear-King says that he is a socialist, a long-standing member of the Labour party, and an NHS dentist. Although he seemed to be asking me for my personal help with the Labour party, I thought that I would telephone him anyway.
	Dr. Kinnear-King has not signed his contract so far. In fact, he has not received one yet, but he has looked at some of its contents. He may decide not to sign it at all, but he says that there is no real treadmill under the present system. If he wants a break, he can take one, and he can also work a bit harder if that is what he wants to do. However, the introduction of targets that he has to meet means that he will get a phone call from the local PCT if he falls behind. He does not like the new contractual treadmill, or the way in which it has been introduced.
	If Dr. Kinnear-King fails to meet his monthly UDA target, the PCT will want an explanation. Technically, it can claw back money from him, or take other action. I hope that most PCTs will wake up to reality and not be so draconian. They need to work with dentists who fail to meet their targets and find out why that has happened, as sometimes the fault lies with the proportions assigned in a mixed service.
	I listened with care to the Liberal Democrat spokesperson, the hon. Member for Falmouth and Camborne (Julia Goldsworthy). This may upset her, but I can tell her that what she said is guaranteed to get dentists walking out of the NHS in droves. Dentists have some difficulties with the present system, as negotiating a change in the size of the contract or the mixture of services that it covers can take two or three months. I am sure that we can do better than that.
	The Minister panned the Opposition motion, but it contains the vital proposal that
	"everyone should have to access to NHS dentistry".
	That commitment does not appear in the Government's amendment, even though it is extremely important.
	I have something else for the hon. Member for Falmouth and Camborne to think about. A patient who presents to an NHS or mixed dentist suffering from pain in her lower-left third molar, for instance, will be offered a choice of treatments—NHS amalgam, for example, or the latest treatments using bonded composites, or a gold inlay, or an inlay-overlay in porcelain. Those might be her options, but what is important in the end is that the treatment gets done: that is what counts, not whether the treatment is NHS or private.
	Under the new contract, the NHS amalgam option means that the dentist will achieve more UDAs. If he does not perform that treatment, he has fewer UDAs. As Dr. Kinnear-King notes in his letter, those UDAs have to be made up with other patients.
	Nowadays, patients want choice. The more choice that they get, the more private dentists' fees will come down. If the fees are too high, the dentists will not fill their appointment books. That shows that the market can also work to the advantage of patients.
	Dr. Kinnear-King offers a better example of that. He says that a patient who comes in with teeth that are intact but badly stained—perhaps by tetracycline, for example—is likely to give him a big, broad, ugly smile. When I asked him what he would do as treatment, he said that he would get out his screaming diamond burr and apply it at 500,000 revs. He would use it to tear around the tooth enamel and put on 16 sparkling new NHS porcelain veneers—

Natascha Engel: Oh!

Paul Beresford: I am sorry to upset the hon. Lady. My voice is not pitched high enough to make what I am saying even more emphatic. The process that I am describing would secure lots of UDAs, and the dentist would have to do it all again after a few years, when the gingiva had moved. Once more, he would achieve lots more UDAs, but what that dentist would want ideally is to be able to offer the patient an opportunity to go for private treatment as well. The best treatment would be to spend hours carefully bleaching her teeth. That would leave her with a broad and beautiful smile, intact teeth, and no need to repeat the treatment.
	However, Dr. Kinnear-King says that he feels that he cannot undertake the bleaching treatment, because he is looking over his shoulder at the avalanche that is the monthly UDA total. Somehow, the Government have to change the position that dentists find themselves in.
	In his letter, Dr. Kinnear-King says that he is a solid socialist, but that he is seriously considering not signing the contract. He intends to go private, but says that he will keep the fees down so that he can offer his patients the service that they need. As I remember from my own experience as a full-time dentist, the problem is that some people cannot afford even low fees.
	The Minister's implementation team will have to look very carefully at how the mixture of NHS and private treatment can be introduced. It must also find a way to ease the treadmill, or dentists will continue to walk away from the NHS. We have enough dentists, and will soon have more than enough, but they must be encouraged to stay with the NHS. The present contract, and the way that it has been implemented, is achieving the exact opposite of that.

Natascha Engel: I am pleased to be able to contribute to this very important debate, although the description of treatment given by the hon. Member for Mole Valley (Sir Paul Beresford) was really quite disgusting. Dentistry affects us all in different ways—

Rosie Winterton: It touches a raw nerve.

Natascha Engel: That is right, it does touch a very raw nerve.

Paul Beresford: I hope that I can help the hon. Lady. Many dentists are moving into the private sector, but I assure her that most patients feel more pain from the white envelope containing their bill than they do from the treatment that they receive.

Natascha Engel: I am grateful to the hon. Gentleman for that, although my recent personal experience with a dentist from Bulgaria does not quite fit with what he describes.
	I want to thank the Tories for devoting one of their Opposition days to dentistry—

Ann Winterton: Her Majesty's official Opposition.

Natascha Engel: I thank the hon. Lady for that.
	The problems associated with getting dental treatment cause more people to come to my surgeries, write to me and send me e-mails than just about any other issue. Their concern is mainly generated by letters that they have received from their dentists explaining that they are no longer taking on NHS patients or are opting out of the NHS. It is important, therefore, to consider why we are introducing these reforms to dentistry.
	Everyone, even the Tories, would agree that there are not enough dentists, that provision is unequal, that access is difficult and that the Government are trying to respond to the concerns of both the public and dentists. Everyone, even the Tories, wants better access to treatment and to promote good oral health. We have heard a lot today about the difficulties that people have experienced, but we have heard almost nothing from the Opposition on proposals for changes that they readily admit are very necessary.
	I do not deny that we are in a difficult situation. Almost all the dentists in my constituency have already decided not to sign the NHS contract and I agree that we need to do more to attract dentists to stay in the NHS. However, would not our time be better spent today discussing some constructive proposals and ideas on how to do that?
	The Government have always worked on the principle that prevention is better than cure. We want to ensure that dental recall periods are based on clinical need, rather than on automatic six-month check-ups. We want to free up dentists' time to see a range of patients and provide additional NHS services, such as promoting oral health.
	I have terrible teeth and have been to many dentists, so I have met far more dentists in a professional capacity than I would want to. All of them, without exception, are committed to providing oral health care and preventive medicine to the highest standard. However, preventive measures are increasingly being hampered by sweets in supermarkets and it is surprising that that has not been mentioned yet today. It was not until recently, when I took my two-year-old shopping, that I noticed a whole bank of sweets, at adult knee-level, lining the channel to the supermarket check-out. Everyone knows that sugar and sweets cause tooth decay, so why is that still happening?

Julia Goldsworthy: I understand that there was a private Member's Bill on children's food, which the Government did not support. Would the measures in that Bill have helped to alleviate the problem that the hon. Lady describes?

Natascha Engel: I understand that we are adopting similar measures. What I would really like to know is why the Opposition have not made any mention of the link between sweets in supermarkets and reforms in dentistry. It sounds a trivial matter, but it is very important when we are discussing preventive medicine. Our oral health plan at least takes a more holistic approach to prevention by aiming to improve oral health and to reduce health inequalities. We propose to do that by increasing the use of fluoride to help to prevent tooth decay, improving diets and reducing sugar intake. I hope that my hon. Friend the Minister will meet the parents jury of the Chuck Snacks Off the Checkout! Campaign, which I intend to join. We will also encourage preventive dental care; aim to reduce smoking to tackle oral cancer—the ban on smoking in public places will go a long way to achieving that—increase early detection of mouth cancer; and reduce dental injuries such as those caused by contact sports. I have heard no positive or constructive proposals from the Opposition to match those ambitious plans.
	I do not claim that everything in dentistry is fine, but I would rather look for ways to improve the situation. I will meet the chief executive of my primary care trust in north-east Derbyshire and dentists in my constituency to find a local solution. These reforms coincide with the reorganisation of primary care trusts. Let us ensure that the outcome of our reforms will enable PCTs to place with an NHS dentist anyone who wants one.
	Poor people are more likely to have poor oral health. Poor people are not in a position to pay for private dental care. We do not want to exacerbate inequalities but to ensure that everyone has access to an NHS dentist. Oral health is too important to be used for political point-scoring, so let us hear some good ideas.

Anthony Steen: I shall make a short speech, because I have one simple point to make. I have some 78,000 people in my constituency and, on the whole, no NHS dentists, so those people have nowhere to go. It is not a question of the NHS being free at the point of delivery: it is failing at the point of delivery. There are no NHS dentists. The Minister knows that we have had busloads of Polish dentists coming to set up in south Devon, and we now have a few of those, but on the whole there are no NHS dentists. That is the first problem that the Minister must address.
	The issue is not about having high-powered discussions about drilling people's teeth out. There are no NHS dentists to drill people's teeth out. I must declare an interest, in that my hon. Friend the Member for Mole Valley (Sir Paul Beresford) is my dentist. He is an experienced and very skilled dentist. I hope that the House will excuse the slight lisp with which I speak, which is because of a slight problem we have had. My hon. Friend's concern is the care of patients and the access that they have to treatment. What do I say to a garage forecourt man who, when I spoke to him the other day, had a very swollen cheek? I asked him what was wrong and he said that he had an abscess. He said that he could not afford to go to the dentist, because they are all private in our area. He said that he had gone to the doctor—that service is free at the point of delivery—and got some antibiotics to try to reduce the swelling. I know how painful an abscess is and the necessity of immediate treatment, so it is criminal that the NHS system does not work in our area.
	What should small children and elderly people do? I have the ninth oldest constituency in the country—not the Member of Parliament, but the constituents—and they are one of the groups of people that need quick access to dentists. Because I have a large rural constituency—it runs 30 or so miles one way and 40 or so the other—we have no adequate public transport. What do we say to such people? We are supposed to be the fourth or fifth—I think that the Chinese have just overtaken us—richest country in the world.
	I do not wish to get into the detail of the contracts, but I wish to ask the Minister whether dentists will end up like opticians, who are now outside the NHS. Everybody applauds the Minister's frankness and her integrity, but is it really the Government's intention to get rid of NHS dentistry that is free at the point of delivery? If not, why do we make it so complicated? What are these units of dental activity? Does it depend on the dentists themselves being very active? It is another example of weasel words—the Government are wonderful at using them. Does it mean that if the dentist rushes around his consulting room, he gets an extra point? Or is it based on something more that he does for the patient?
	Can the Minister tell me why one dental practice in Plymouth is being offered £22 per unit of dental activity, when the next-door dental practice—I know them both, although I have not used them both—is offered only £14 per UDA? What is wrong with the £14 UDA dentist? Will people who go to the £22 UDA dentist get better dentistry? The Minister is trying to marry two services that are irreconcilable—a salaried service and an individual, private service. The result is that few people will be offered free services by their dentist.

Geoffrey Cox: Is my hon. Friend aware that the problem in his constituency, which is contiguous with mine, is in fact Devon-wide? I have just been sent an e-mail from a Devonshire dentist who tells me that in north Devon
	"2 practices have already deregistered for adult patients. 3 practices are now on the brink of refusing to sign the new contract."
	In my constituency, no dentist is accepting national health service patients. The situation is the same across the entire county.

Anthony Steen: People will clearly be able to tell which constituents come from Devon; they will all have black teeth and swollen cheeks. They will all be suffering from bad teeth because Devon does not have NHS dentists. This is not just about Totnes; my constituency covers parts of five local authorities—the Dartmoor national park, Devon county council, Teignbridge district council, South Hams district council and the Torbay unitary authority. They all have the same problem.
	I understand why the Minister is no longer in her place; she can no longer face us. What are we to say to people in Torridge and West Devon and in Totnes? From what the hon. Member for North-East Derbyshire (Natascha Engel) said, if she had visited only NHS dentists she would probably have no teeth left—perhaps she does not. We cannot tell a nation of 60 million people, including children and the elderly, that the NHS is free at the point of delivery and then produce the wicked joke that there are no dentists.
	What do I say to my constituents? The Minister knows about my concerns, because I have written to her over and over again about one person after another. I am embarrassed to represent an area in the world's fifth-largest economy and tell my constituents that they cannot have free dental health provision.

Natascha Engel: Has the hon. Gentleman discussed the matter with his PCT? What was its response about NHS provision for dentistry?

Anthony Steen: I am impressed by my PCTs, which are responsible and highly committed organisations. The snag is that they cannot find dentists. I do not know whether something is wrong with the contract. In any case, I am not concerned about the machinery, but about every person I see in the street who is in pain. I represent them, so I say to the Minister that she must do something about the contract so that people can receive free dental care. She must provide the dentists. I do not mind if she brings in busloads of Bulgarians or Romanians. She can bring them in from any country in Europe. She misunderstood my earlier question—I do not object. The Prime Minister misunderstood me too, but he regularly misunderstands my questions. The point is: what are we going to do about the situation? I cannot represent a constituency when I know that people will continue to be in pain and will have to find money that they do not have to pay for private dentistry.

John McDonnell: I apologise to the House as I shall have to be discourteous and leave soon after speaking. I have a ministerial meeting at 3 o'clock on a pressing constituency matter, but I shall try to return for the wind-ups so that I can hear the ministerial response.
	Over the past six months, I have convened meetings of London dentists. We have held two meetings at the House of Commons, as well as meetings with individual groups of dentists elsewhere. One of the meetings in the House was in November and the other in February, and I am grateful to the Minister for the access that she gave to civil servants, who attended one of the meetings, and also for the correspondence she provided that enabled us to share information about the new contract procedures with the dentists.
	Like many dentists, I welcome the Government's policies with regard to the additional resources and their commitment to dentistry. I was impressed by the parliamentary Labour party briefing and can understand why on this occasion it was circulated more widely than usual, given the additional resources it described, including the £368 million for improving dental services in July 2004, the 19 per cent. increase since 2003–04 and the nearly 1,500 new dentists. I welcome all that, but I want to raise issues about the method of introduction of the new contract, especially the timing, some of which relate to London and others specifically to my constituency.
	My colleague, the hon. Member for Ruislip-Northwood (Mr. Hurd), has pointed out that the contract is being introduced in our area at a time when Hillingdon primary care trust is struggling with a deficit of £25 million. It looks as though the amount may be nearer £30 million—it varies week by week. That has resulted in an inability to manage change generally and impedes the introduction of the new contract. We are on our third chief executive in less than four months—and counting. The PCT's struggles with its deficit have led to problems in the introduction of the contract.
	I welcome the Minister's statement about the implementation group and the review mechanism, which is a real breakthrough and was one of my recommendations. However, the Department may need to intervene in some instances—such as Hillingdon and other parts of London—where there has been a failure to manage the introduction of the contract effectively. I have two brief examples of the impact on my constituency.
	The first relates to the Hayes dental practice in Station road, Hayes, where Dr. Stern has encountered a problem to which the Minister referred earlier, although it was not addressed locally in the way that she described. Last year, during the reference period, two of Dr. Stern's colleagues left and he was unable to recruit for some time. As a result, the PCT's assessment of his activity and income levels was not an accurate reflection. In December, he thought that he had held a co-operative meeting with the PCT. He contacted it regularly after that but heard nothing about the contract. On Thursday 23 February, he received a package containing two copies of the new 135-page contract, with an accompanying letter that stated:
	"You will be aware that you need to have signed the contract and confirmed this to us by no later than midday on Friday 24th."
	So he was given only 24 hours. Furthermore, when he read the contract he discovered that it did not take into account the representations that he made about staffing and activity levels during the reference period, so his income will not be as before and he will have to lay off staff, including not only his dentist colleagues but also support staff.
	I accept what the Minister said about appeal procedures, but that dentist thought that he had gone through that process during his negotiations with the PCT. The Department may have to intervene in such cases, where the PCT is clearly struggling to manage the introduction of the new contract.
	The second example affects colleagues in Hillingdon and Ealing and relates to the orthodontics centre in Northolt opened by Sarinda Kumar over the past 12 months. We all welcomed the centre, to which the dentists involved committed significant personal outlay, raising capital of about £450,000. However, because the centre opened mid-year, the contract value is not sufficient to reflect the new service it provides. As far as I am aware, there has not been much response from local PCTs in terms of recognising those needs.
	The orthodontics service at Hillingdon hospital has also suffered due to the PCT cuts, which relates to a general point about the priority accorded to dental services in several PCTs. There seems to be a lack of sufficient specialist advice from local dentists in the PCT and a failure to acknowledge the need to involve them fully in discussions about the roll-out of services generally and in consultations about the implementation of the contract.
	Other general matters were raised that were not specific to my constituency or London overall. There is a concern that the units of dental activity do not fully reflect the importance of prevention. There may well be a need in the review process to find out whether a specific, separate UDA is necessary for prevention and dental health promotion.

Geoffrey Cox: Does the hon. Gentleman agree that, if a charge of £183 is levied for a single crown and precisely the same charge is levied for doing six crowns, the incentive for those whose teeth are becoming bad will be to wait until they are sufficiently bad to maximise the value for money that they get from the charge that they pay?

John McDonnell: Such issues may well arise during the review process, because the one thing that neither the Government nor any of us want to do is to provide any disincentive to people turning up for health treatments.
	Another concern was raised by the London dentists. PCTs obviously set their own targets and the budgets are allocated and then capped. The concern is that, particularly in areas such as mine and in London, PCTs will put pressure on individual practices to increase their income to a certain level from charging. In other words, that is a perverse incentive in the system, thus undermining NHS work as well.
	There are concerns about children and exempt patient contracts, which will be determined by PCTs. Given the lack of local engagement with adequate dentistry advice and support, the decision-making process on how such contracts are allocated needs to be closely reviewed by the Department in the first year of operation.
	A number of dentists have said that they must introduce new computer systems at considerable cost. The information that we received from yesterday's meeting is that those costs range from about £10,000—with one practice, it was £35,000—and that the allocation that they receive goes nowhere near recovering those costs. In fact, less than 10 per cent. is recovered in some instances and a lot less than that in many others. That will impact on the overall delivery of service.
	I believe that the Government have exceptionally good intentions. There is real commitment, and it has been backed by resources. I congratulate the Minister on her personal commitment to the development of dentistry policy. We would not have come this far in the allocation and investment of resources and the priority for dentistry without her personal commitment, but those intentions are being frustrated in many constituencies, particularly mine, because of the financial crisis in the PCTs themselves.
	I accept that an element of ring-fencing has gone on for three years, but the concern—it was raised by the hon. Member for Ruislip-Northwood—is that beyond those three years, no matter what statutory duties are placed on PCTs, dentistry will be a soft option when prioritising expenditure. The Government will need to monitor the situation closely over the next six to 12 months in particular. In special circumstances, such as mine, direct intervention by the Department may be needed if the system is seen to be failing and we are losing NHS dentists.
	I welcome the implementation group review and the structure that has been announced today, but I suggest that, first, the review should report in six months and then in 12 months, and that that information comes before the House. We could then have another debate—not on an Opposition day, which sometimes degenerate into knockabout rather than real debate—on that report to find out what adjustments need to be made to the system. There is a commitment on both sides of the House: we want dentistry to improve in this country, but we want it to do so in a way that brings people with us. I do not think that dentists are convinced about the system. If we introduce the appropriate adjustments as we learn from experience, we will be able to retain people in the NHS and to work together to improve the system overall for all our constituents.

Mark Lancaster: I realise that time is marching on, so I will keep my comments as short as possible.
	I empathise with the hon. Member for North-East Derbyshire (Natascha Engel). I, too, have lost my two front teeth, although I did so by failing to obey the first rule of cricket: "Always keep your eye on the ball."
	I am unsure where in this country the Government are fulfilling their pledge of access for all to an NHS dentist—perhaps in Liverpool or Doncaster, but certainly not in Milton Keynes. Indeed, in an answer to a question posed back in June by my hon. Friend the Member for Isle of Wight (Mr. Turner), who is not in his place, we discovered that just 62 per cent. of children and 39 per cent. of adults—an overall rate of just 45 per cent. of people—are registered with a dentist in Milton Keynes. The figure is down considerably—in fact, 10 per cent. or some 20,000 people—since 1997. That is an extraordinarily low figure. If just 45 per cent. of the population of Milton Keynes is registered with a dentist, about 122,000 people in my city are not.
	Perhaps the Minister believes—I am sure that she does not—that my constituents simply do not want to register with a dentist. If so, I point her to a recent survey carried out by Milton Keynes PCT showing that 79 per cent. of people who are not registered with an NHS dentist would like to do so—a fact that is backed up by my overflowing postbag of correspondence from many constituents who have written to me on the issue. For example, my constituent, Mrs. Byrne, who wrote to me only this week, is representative of many young mothers when she says:
	"I have a 9 month old son and I am 7 months pregnant, I have been advised to go to the dentist for a check up but unfortunately cannot find one in Milton Keynes. My son's first teeth are now through and I need a dentist for him too. I am quite disgusted that I have an NHS maternity exemption certificate so that I can go to the dentist but the NHS are not providing the dentists for myself and many other people in my situation to attend."
	Perhaps the Minister, who seems to suggest that training dentists is one, if not the main solution to the problem, believes that my constituents are simply not looking hard enough for a dentist. If so, perhaps she would like to meet my constituent, Mrs. Carter, who in an e-mail this week says:
	"I desperately need an NHS dentist who will accept my two children, my husband and myself as new patients and I have phoned every number on the list provided by the PCT and none of them are taking on new NHS patients. I refuse to go private as my husband and I have paid far too much in National Insurance to have to pay for it again."
	That raises an interesting question about national insurance contributions to which I will return in a moment, but is it really that hard to get a dentist in Milton Keynes?
	Like many people in Milton Keynes, I am not registered with a dentist. Indeed, I am tempted to ask my hon. Friend the Member for Mole Valley (Sir Paul Beresford), who is no longer in his place, whether he will start accepting NHS patients, but I sense that that would probably be unfair. I was able to find just one practice that was happy to accept new patients, but there is a catch: they must be under the age of 18 and they would qualify only if both parents were involved. However, I accept that that has been addressed.
	As a Back-Bench Conservative MP who may feel that we have absolutely no influence in the House, I am delighted that my very first question in the House was to the Minister on this subject. I asked her back in June whether, effectively, she had replaced the access-for-all-to-an-NHS-dentist policy with a buy-two-get-one-free policy. So I am delighted—I am sure that the people of Milton Keynes are, too—that I seem to have had some impact on the House.
	If I were a cynic, I would ask whether, in reality, the Government are pursuing their policy in the hope that people will perhaps get used to going private and therefore not want an NHS dentist, with possible effects on funding dentistry in the future. So who is to blame? I am sure the Government are keen to blame dentists, but I am afraid that I do not blame them. Having talked to my local dentists, it is clear to me that they are doing the very best that they can in extremely difficult circumstances. They do not want to turn away NHS patients, but seem to have little choice.
	Dentists have serious concerns, some of which have already been raised by my hon. Friends, so I will focus on just two—first, the time scale for the new contracts. Certainly, in Milton Keynes at least, they were given their contracts just eight days ago, yet they were expected to return the first draft by yesterday. The second concern is the security of the new contracts. Although they will last for three years initially and have been ring-fenced, there appears to be little security beyond that point. For example, if an associate leaves a practice, there is absolutely no guarantee that the PCT must award a contract to the same practice. It is therefore very difficult for dentists to plan the expansion of their practices beyond the three-year period. I should be grateful to the Minister if she considered that issue.
	Perhaps we should blame our local primary care trusts, but to be fair to Milton Keynes primary care trust, which is being forced to swim against the tide because of an ever-increasing population, it is at least trying to address the problem, although the early signs are that the results of its efforts are, at best, mixed. It sent out a mixture of practice and individual contracts, but 20 per cent. of dentists have so far refused to accept a contract. As of yesterday, 40 per cent. of dentists had not returned their contracts, and at least a third of the dentists who had returned and accepted their contracts had done so in dispute while waiting for further negotiations with the PCT. Those statistics are hardly encouraging. Given the rapidly growing population of Milton Keynes, Milton Keynes PCT is one of the hardest pressed primary care trusts in the country, although I am confident that it will try to do the right thing when funding dentistry in Milton Keynes.

Stephen Hammond: My hon. Friend has obviously had extensive conversations with his primary care trust. Has it given him any indication of the possible implications of the 12-monthly block payments that are coming through on its funding and deficit next year?

Mark Lancaster: My hon. Friend makes a valuable point. There is deep concern about that matter in Milton Keynes, as I am sure there is in his constituency. Although I am confident that my primary care trust, which is staffed by excellent people, will try to do the right thing, I am worried that once we get beyond the three-year ring-fenced period, there will be a temptation to divert funds for dentistry elsewhere. I hope that the Minister will ensure that that does not happen.
	Finally, may I pass on a question that many of my constituents are keen that I should ask the Minister? Given that they have paid their national insurance contributions yet failed to get an NHS dentist, will she give them their money back?

David Burrowes: It is a pleasure to follow my hon. Friend the Member for North-East Milton Keynes (Mr. Lancaster), who gave us several examples of problems in his constituency that are reflected in mine. The Government's proposals on NHS dentistry are characterised by being target driven, centralised and shambolic, although perhaps we should not be surprised because that is a description of their general approach to the NHS. Several Labour Members focused their comments on the relatively high salaries of dentists, but it should be noted that Conservative Members are worried about access for patients, which should be the focus of the Government.
	I want to talk especially about younger dentists because the proposals have been presented as representing a bright future for NHS dentistry. However, is that the case? I suggest that they are yet another nail in the coffin for NHS dentists, especially young dentists. I concede that funding, recruitment and the number of training places have increased, which is welcome, but how will that affect in practice young dentists who want to be part of the supposed bright future? Will my constituents get proper access to a dentist? I suggest that the contract is an obstacle to any of the relatively good progress that has been made and a road block for young dentists.
	Let us consider the situation for young women dentists, especially those who are young mothers. One of my constituents, Mrs. Surabaskaran, has told me about her experiences, which are no doubt replicated throughout the country. She is an NHS dentist who graduated in dentistry in 1998 from Kings college school of medicine and dentistry and looked forward to a future in the NHS. She was on maternity leave for five months during the relevant period over which her contract value was calculated, and has been in negotiation with the PCT to get an appropriate contract value. However, her maternity leave has been wholly discounted, so she has effectively been left with a contract that would be worth half her salary. Although she has 2,000 patients on her list, there is a risk that she will be forced out of the NHS because the PCT has stonewalled by saying that it has insufficient funds to address the situation.
	The Minister might well point out that the framework proposals said:
	"Allowances will be made where the practice has carried a vacancy"—
	for example, due to maternity leave. It was suggested that allowances could be made for dentists who were
	"increasing or reducing, or planning to increase or reduce the amount of NHS care they provide"
	during the relevant period. However, despite all the good intentions in "Framework proposals for primary dental services in England in 2005", the reality is that a young dentist such as Mrs. Surabaskaran is being left short when negotiating her contract because the local PCT refuses to award a contract with the value that she should properly have.
	As the PCT has said no to Mrs. Surabaskaran, she must use the dispute resolution procedure for the contract and go to the Secretary of State. However, where will that leave her? Will she be guaranteed a better value than that which she has been offered? Given that the contract should have been signed yesterday, she faces the precarious predicament of endangering not only her future career in the NHS, but the 2,000 patients who are on her list. Is the process for dispute resolution appropriate? Should the Secretary of State be the binding determinant of a contract? Such a procedure might be appropriate in different parts of the NHS, but should the Secretary of State make decisions about a party who is a sub-contractor risking private capital? Again, the controlling hand—the dead hand—of the Government is at the heart of the proposals. We have heard that D-day has passed, so many NHS dentists, especially young dentists, face chaos.

Stephen McCabe: The hon. Member for North-East Milton Keynes (Mr. Lancaster) said a moment ago that a three-year contract was not sufficient, although these days most people would be happy with a three-year contract. However, the hon. Member for Enfield, Southgate (Mr. Burrowes) seems to be saying that the contract should have no obligations and that there should be no mechanism to resolve disputes. Is he seriously saying that we should simply pay the money and give no further attention to what happens? Does he think that that would be credible?

David Burrowes: The debate is about the proposals that the Government have put in place. I hope that the hon. Gentleman agrees that there has been discrimination against a young dentist who has been on maternity leave. She has been left with a bureaucratic and centralised resolution process. She effectively must choose between not continuing to provide NHS care, or meeting the needs of her 2,000 NHS patients.
	I want the Minister to hear the words of Mrs. Surabaskaran loud and clear. She says:
	"If the dispute is not resolved speedily with due consideration for my maternity leave I will be forced to seek a job in the private sector."
	However, she does not wish to do that.

Rosie Winterton: In the circumstances that the hon. Gentleman describes, I believe that his constituent could sign the contract with a note to say that there is a dispute about some aspects of it.

David Burrowes: I am grateful to the Minister for that point, but my constituent has no guarantee that she will receive her due reward. She runs the risk of being given a contract with a value that is half what it should be. Neither she, nor any other NHS dentist, has an individual contract guarantee.
	We must also consider the situation facing graduates. We have to welcome the fact that 100 extra dental school places were announced on 26 January, but is that the only way to secure the future of NHS dentistry? The Dental Practitioners Association says:
	"The current NHS access problem"—
	the concern is not so much about salaries or training places, but NHS access—
	"is caused by the large gap between the terms and conditions offered by the NHS and those in the private sector. This has led to an outflow of dentists from the NHS which has been exacerbated by the prospect of an inflexible and inefficient new NHS contract in April 2006 which is generally expected to make working in the NHS less desirable to most dentists."
	That is the case, particularly for vocational dental practitioners. How do they fare with this contract? If one looks at the detail of the contract, one sees that all revenue associated with vocational training will be put on hold during the relevant period and will be removed from the contract value. The employment of vocational dental practitioners will essentially be at the behest of the primary care trust. We have heard already of deficits among PCTs, and the situation is the same in my constituency. It is fair to suggest that the first to feel the squeeze in the PCTs' capacity to deliver NHS dentistry will be vocational dental practitioners, who will be unable to find a place to pursue their training. Many a dental practice is not receiving, in its units of dental activity, any recognition of vocational dental practice. The PCTs do not have to provide that recognition. They have been asked by the Government to do so, but there is no specific requirement to take any account of the vocational route that we would wish many people to follow.
	Finally, I turn to the care given to patients. It is at the heart of the motion, which refers to support for preventive work and the achievement of good oral health. The Minister says that it is all about preventive care, but what is the reality? As dentists in my constituency tell me, no real value is given to preventive treatment in the UDA system. Root canal treatment is worth three points, as is extraction. Root canal treatment usually takes three 45-minute visits, while extraction takes half an hour, so there will be an incentive to take out a tooth rather than give root canal treatment, despite their having the same UDA value of three points. Dental repairs too, will come straight out of the dentist's salary, so there will be an incentive to fit fewer crowns and more fillings. The contract looks more to points than to patients.
	I should conclude because I have gone way over the time—eight minutes—that dental practitioners will be allowed by the contract for an examination, X-ray, and scale and polish. The question is not so much whether there will be time for NHS dentists to give quality care but whether there will be any access at all to NHS dentists.

Paul Rowen: I am grateful to HerMajesty's official Opposition for initiating this debate, the second on this subject. The first was last October and was initiated by the Liberal Democrats. We were told then by the Minister that we should wait until the new contracts had come out to see what would happen. I have to tell her that in my constituency it is no longer a case of saying that NHS dentistry is in crisis; NHS dentistry simply does not exist. In 1997, 58 per cent. of the population was registered with an NHS dentist. Last year, that figure had dropped to 35 per cent. The Minister herself admitted, when I questioned her, that that is not progress. I have asked on numerous occasions, both verbally and in writing, what she will do to improve the situation.
	Since Christmas, the situation in Rochdale has got worse. Last December, residents received letters from the last remaining full-time NHS practice informing them that from 1 April this year it was pulling out of NHS dentistry completely. I asked the practitioner why, and he replied that he simply did not believe that the new contract, with its emphasis on dental units, would do anything to improve what was already a hard-pressed and desperate situation. From 1 April, there will be no full-time NHS dentist working in my constituency.
	I listened very carefully to the Minister to see what the new contract could offer us. She talked about what it will mean to existing dentists, particularly with regard to the reference year. How does that create new money to enable Rochdale PCT to employ more dentists? It does nothing in that regard. The dentists have to be in the system already, receiving NHS money; no NHS money will be transferred to non-existent "ghost" dentists.

Stephen Hammond: We have heard a lot about access, which is the key point. The hon. Gentleman has described what is happening in his constituency, and that has been the tale throughout the House. One question that the Minister has to answer today is how many dentists who had previously resigned from the NHS will come back to the NHS under this contract. Surely the answer is zero, and that is a failure of access.

Paul Rowen: I agree entirely. The situation in the borough of Rochdale will get worse because dentists in the Heywood and Middleton constituency—I think that there are eight—have said that they, too, have no intention of signing the new contract. A borough that already has a very poor record of dental health will be left with virtually no NHS dentists. Yes, we have a walk-in centre, and it is fully committed, but it is doing nothing in the way of preventive work. It simply cannot cope with that on top of the emergencies that it deals with.
	In the past 12 months, we have seen new dental practices open in neighbouring areas, such as Radcliffe and Bury. People in my constituency have queued from 5 o'clock in the morning to get themselves on the list at those practices. A dentist from Zimbabwe recently opened a practice in the neighbouring constituency of Oldham, East and Saddleworth, and within four days his list was full. Rochdale needs 10 dentists to treat those people who cannot afford to go to a private dentist.
	When the Balderstone surgery announced that it was pulling out of the NHS, a constituent came to see me. He said that he had been told bluntly that if he wanted to stay with the practice he had to be prepared to pay £15 a month. There is no way that that gentleman could afford that sort of money. I wrote to the PCT, pointing out the situation with the last remaining NHS practice and asking what it was going to do and what advice it could give me to pass on to my constituent. The advice was laughable; it was to look at the website. When one looks at the website—not everyone has access to the web—one asks, "Where are the dentists for Rochdale?" They simply do not exist. I really am sick of hearing talk about this new contract and what it is supposed to deliver, when the few dentists left in the NHS are being driven out as a result of the obsession with targets.
	We need to hear concrete proposals from the Government to address real shortages. I have been asking since May, when I was elected, what the Minister will do to deal with the crisis in my constituency. Everything that she has done so far has made the situation worse. In the next few years, we will see a dramatic rise in dental ill-health; we will see more expensive treatment having to be carried out; and we will see people's general dental health deteriorating greatly. That is not why the NHS was created. It is not what the Prime Minister promised us back in 1999, when he said that everyone who wanted an NHS dentist would have one within two years. The reality is that fewer and fewer people in my constituency have access to a dentist.
	I have asked for a meeting with the Minister. I invite her to come to Rochdale and explain to people why we cannot get NHS dentists in the constituency. They deserve answers and we ought to have them now.

Mark Pritchard: I applaud the Minister's courage in coming to the Chamber for the debate, given that there is opposition on all Benches, including the Labour Benches, and opposition outside the House to the Government's proposals.
	I praise the work of dentists throughout Shropshire, especially in my constituency. I praise also the professionals who work in orthodontics and dentistry at the Princess Royal hospital in my constituency. They all provide a valuable and vital health service for my constituents.
	I note that the Government have tried to shift the blame from them to primary care trusts and to dentists. However, it is the Government who will be funding PCTs. Those trusts, with scarce resources, will have to apportion dental contracts accordingly. Given that Shropshire County PCT and Telford and Wrekin PCT are already struggling financially, that does not hold out much hope for my constituents with dental problems for the months ahead. That is clearly of concern to them and to me.
	I remind the Minister of the Prime Minister's comments at Question Time today—that we should trust professionals. We have heard that mantra over many months. We were told in the context of the Terrorism Bill that we must trust the professionals. We were told, "The police are asking for X and we should give them X." Why is it that on this issue the Government are not prepared to listen to the professionals? Let us listen to the words of the British Dental Association. It says:
	"The Government's aims of securing patient access, improving oral health and raising the quality of patient care will not be achieved by the imposition of this target-driven NHS contract."
	If the Government are serious about listening to professionals, let us see them listen to dental professionals on this point.

Eric Martlew: Will the hon. Gentleman give way?

Mark Pritchard: If the hon. Gentleman's intervention is brief, I shall certainly give way.

Eric Martlew: I shall be extremely brief. The hon. Gentleman says that we should listen to professionals, and I accept that. Did he vote against part of the Terrorism Bill?

Mark Pritchard: I am tempted to go down that route. I know that Labour Members do not want us to address serious issues on dental care. That being so, I shall stick to the substantive points that other Members have raised. I shall be happy to discuss the point that the hon. Gentleman has raised outside the Chamber at a later stage, at his cost, over a cup of tea.
	It has been said that it is the poor who will suffer, and that is absolutely right; and that the elderly will suffer as a result of the proposed changes, and that is absolutely right. In addition, everyday families and single people—in fact, everybody—are likely to suffer in the light of the proposed changes.
	The Minister has reminded us of the number of dentists entering or opting in to NHS contracts. The overall net figure, including those who have opted out of NHS contracts over the past few months, or who are likely to do so, shows that there will be a drain away from the NHS. There will be fewer dentists providing NHS treatment. I accept that some centres have opened, and I know that in the neighbouring constituency to mine—Telford—there will be a new centre, but that will not meet the needs of all the constituents in Shropshire. The demand will not be met. Unfortunately, there is a net loss overall.

Martin Horwood: I wish to reinforce the point that the hon. Gentleman has just made. When I spoke to my primary care trust last year, it was putting various measures in place—no doubt applauded by the Minister—and hoped to achieve 21,000 new NHS registrations. When I met the members of the trust only a week ago, they told me that they were expecting 14,000 fewer registrations because of the likely impact of the new contract. This is NHS dentistry in crisis.

Mark Pritchard: Absolutely; crisis is an appropriate word. We have a crisis in health care generally, and it is not the fault of the professionals who are working in our hospitals, our dental practices and our primary care sector. On so many of these issues, the fault lies with the Government. We have seen today Ministers smiling and taking these issues lightly, no doubt with extremely healthy teeth. They should take these issues far more seriously and look after my constituents who are unable to access NHS dentists.
	The Minister might be aware—I have discussed this previously with her—that the nearest dentist for some of my constituents in, for example, the wonderful market town of Shifnal, is as far away as Lichfield. It is totally unacceptable that young mothers, often having to use public transport, have to change two or three times to access the NHS. As my hon. Friend the Member for North-East Milton Keynes (Mr. Lancaster) rightly said, given that people have paid their taxes, the very least that they might expect is the standard of NHS dental care that they enjoyed over many years. There has been criticism of past Conservative Governments, but at least people could register under the previous Conservative Government with an NHS dentist. People will not be able to do so given the present proposals.

Kevin Barron: Will the hon. Gentleman give way?

Mark Pritchard: I recognise that my colleague is a distinguished Member on health matters. Unfortunately, one other Member wishes to speak in the debate. That being so, I shall give way on another occasion, perhaps.
	Many orthodontists in my constituency have concerns. We are likely to lose an orthodontist place at the Princess Royal hospital, which will result in people waiting even longer to receive orthodontic treatment. Orthodontics should not be an aside to general dental services. There are 550 patients who access orthodontic care at the Princess Royal hospital. They will be unable to access future care if we do not replace the orthodontic practitioner that we have lost over recent weeks. That will lead to a decrease in oral health. As I said earlier in an intervention, I think that in the long term we shall see an increase in gingivitis. Sadly, we may even see an increase in cancers of the mouth that are not picked up by dentists and orthodontists.
	In conclusion—I am rushing through to try to be helpful to other Members—the Minister said that the Government would review dental and orthodontic contracts once they had been in place for some months. I ask the Minister for that review prior to the introduction of the contracts. If she is to consult the professionals then, why does not she listen to their advice now? Surely that is a logical position to take.
	My constituents are being disfranchised as a result of the Government's policy. They are likely to be more disfranchised from access to NHS dentists as a result of the policies in the new dental contracts. This flies in the face of the Prime Minister's saying in September that all people will have access to an NHS dentist within two years. Clearly, we and my constituents have yet again been misled by the Prime Minister on a key health issue.

Stephen Crabb: I shall be brief. We have had an interesting debate, and many hon. Members have made my points for me.
	I shall draw on the Welsh experience, not just because it is St. David's day, but because many of the things that we have experienced in Wales are now being experienced in England. What has happened in my constituency offers a glimpse of what Members representing English constituencies will face. Pembrokeshire has the lowest rate of adult access to NHS dentistry in England and Wales. Just 15 per cent. of adults are registered with an NHS dentist, and 85 per cent. do not have access to NHS dentistry, which has all but collapsed in west Wales. One by one, dentists have exited the NHS, so their patients have had to sign up to private schemes.
	In the past two years, the Pembrokeshire local health board, which is responsible for commissioning, has made great efforts to tackle the problem, to the extent that it has employed dentists directly, but it has fought against the tide. I do not wish to be partisan, but it should be placed on the record that all of this has happened on Labour's watch. What would have happened if the people of Pembrokeshire had been told in 1997 that within eight years they would witness the almost wholesale destruction of NHS dental services?

Martin Horwood: It is a little disingenuous of the hon. Gentleman to say that all of this has happened on Labour's watch, because the peak in NHS dentistry registration occurred in 1992. It started to fall because of the new contract introduced by the last Conservative Government.

Stephen Crabb: My memory may fail me, but I do not recall people queuing from 5 o'clock in the morning to sign up with a dentist under a Conservative Government. The truth is that NHS dentistry has all but collapsed in parts of the country under the present Government. Labour Members ought to be extremely concerned about the trends in my constituency developing in constituencies that they represent. My constituency had a Labour majority of 9,000 at the end of the 1990s, but as NHS dentistry unravelled so did that majority.
	Few issues galvanise so many people from so many different backgrounds as the NHS. The Labour party should understand that better than anyone, as it claims to be the party of the NHS. The NHS serves everyone, and people are attached to it, so they are rightly angry when they wake up one day and find that their NHS dental service, for which they helped to pay, no longer exists and they are required to sign up for a private sector service.
	In conclusion, the new contract represents a massive missed opportunity to reinvigorate NHS dentistry. Not one dentist to whom I have spoken in Wales or England believes that the clock can be turned back, and they are very pessimistic indeed about the future of NHS dentistry in this country. The truth is that the NHS dental service is dying under the Labour Government.

Andrew Murrison: We have had an instructive debate this afternoon, with a total of 11 Back-Bench speeches, all of high quality. I have received reams of correspondence from dentists about the new contract—none of it is complimentary. Ministers will be particularly interested in messages I have received from Leicester, Doncaster, Liverpool and Birmingham. Most of them use parliamentary language, but some do not. I should like to begin by sharing one that I have just received from Doncaster, as I know that the hon. Member for Doncaster, Central (Ms Winterton) will be interested in it:
	"As of 1020 hours Doncaster time, we have not received a contract . . . I can state with a fair degree of confidence 100 per cent. of dentists in Doncaster have not agreed to the new contract."
	The Minister made great play of apparent demands from patients for a simplified, more transparent charging mechanism, but I can honestly say that I have not met a single constituent who is exercised about the complexities of the charging system. However, like my hon. Friends the Members for Totnes (Mr. Steen), for North-East Milton Keynes (Mr. Lancaster) and for The Wrekin (Mark Pritchard), as well as the hon. Member for Rochdale (Paul Rowen), I have received shedloads of letters about deteriorating access to NHS dentistry. That is not surprising, because in the strategic health authority area serving my constituents only 25 per cent. of people are registered with an NHS dentist. I am horrified to hear that in the constituency of my hon.   Friend the Member for Preseli Pembrokeshire (Mr. Crabb) the figure is even lower at 15 per cent.
	As constituency MPs, we know—and Citizens Advice recently confirmed it—that access to NHS dentistry is of overwhelming concern to dental patients, despite the Prime Minister's famous pledge in 1991, which, I note, is not reiterated in the Government amendment to our motion. The contract is set to make matters much worse. Community Dental Centres is a group of nine major dental practices in the west country that cares for 100,000 patients. It announced yesterday that unless there are changes to the contract it is likely to pull out of NHS dentistry. It points out, as did the London local dental committees that I met last night with the hon. Member for Hayes and Harlington (John McDonnell) and my hon. Friend the Member for Ruislip-Northwood (Mr. Hurd), that payments will be based on dental activity, which is not the same as dental care. Activity implies the treadmill, which is precisely what we thought Ministers were keen to remove. Dentists want to offer care to patients, not activity, and the Minister ought to know the difference between the two.
	The consumer organisation, Which?, and the National Audit Office appear united in their belief that primary care trusts are simply not up to managing the new contract. Which? has asked for a clear audit framework to measure the impact of the changes. That would at least allow us to draw breath and reconsider after a few months or a year. I am pleased to hear that the Minister is going to put in place a review group and implementation team. I hope that it meets in six months' time and in 12 months' time and that at each of those points, as the hon. Member for Hayes and Harlington suggested, there is a report that is debated in this place.
	What is the Minister doing about contractual arrangements for practices that have grown in the test year? Yesterday, I met a full-time NHS dentist from south-west London who is preparing to sack three members of staff on 1 April because his practice growth has outstripped his allocation of units of dental activity. That problem, which was well described by my hon. Friend the Member for Enfield, Southgate (Mr.   Burrowes), is particularly severe for young orthodontic practices, because they are paid eighteen months in arrears. An orthodontist from Bristol wrote to the Minister, with a helpful copy to me, to say:
	"The financial disaster we are facing is due to the methodology adopted by the Department of Health for deriving contract values for orthodontic practices."
	On the same theme, a Birmingham dentist writes:
	"One Dentist in South Birmingham extended his practice to 6 Dentists last year from 3 to accommodate the extra patients seeking NHS treatment, he has been told his budget is such that the 6 dentists must work part time or 3 must leave, as his funding is based on the period when he had 3 dentists. This will leave about 4000 patients without a Dentist."
	Clearly, at this late stage there is considerable confusion about how the anomalies that the test year will introduce are to be resolved. This is the eleventh hour.
	I am assuming that moneys released from the many dentists who opt out will be reallocated to the few who are expanding their services or to the Government's massively expensive dental access centres. However, practices willing to expand have not been told that that is the case. Can the Minister offer us a time scale? Why are we getting reports that the few high street dentists still willing to take NHS patients are being turned down if there is a dental access centre nearby, despite the big cost disparity? I suspect that it is because dental access centres are a Government pet project that must be supported at all costs.
	More concerns emerge from Birmingham on the subject of out-of-hours cover. It appears that the contract, taken with PCT deficits, will mean that post-1 April cover will be basic, to say the least. Birmingham dentists have been told that haemorrhage and swelling that compromises the airway are the only items to be regarded as dental emergencies, which means that dental pain is not. Dental pain is the most common form of dental emergency, and for those of us who have suffered it in the middle of the night it truly is an emergency. Are we really to have a contract that will allow people in this country, in the 21st century, to struggle through the night with acute dental pain?
	I have had a raft of messages from dentists over the past six weeks or so. I will read just a few of them. They would fill two box files and, sadly, time does not permit me to read them all. A dentist from Coventry writes to me with more than a hint of desperation:
	"Three of my best friends with over 80 years of NHS experience between them have sent out their conversion letters."
	That is, conversion to private practice. He continues:
	"These are dentists who have stuck with the system until now. There are many hanging on there by their finger tips hoping this disaster will be stopped on Wednesday. They are torn because of feeling for their patients."
	He signs off,
	"Best of luck on Wednesday."
	A dentist from Yorkshire says, typically more briefly:
	"if these reforms come in I doubt there will be an NHS dental service worthy of the name in 3 years."
	A general dental practitioner from Colchester writes:
	"We will reduce our NHS commitment. Accordingly, letters will go out to my NHS kids/exempts shortly, and my associate will keep what little NHS funding remains, prior to a move to private practice within 12 months. It's the only solution that I can come up with that allows me to keep people in a job. The alternative is to make everybody redundant!"
	That raises an important point because, in Committee, the Minister said that primary care trusts could provide children-only contracts. However, since children and exempt adults do not pay the 80 per cent. contribution, how will PCTs that operate with massive deficits manage to provide such targeted contracts? The contracts that they let will depend heavily on the 80 per cent. co-payment.
	The contract is clearly too rigid. The British Dental Association rightly believes that dentists will overdo their UDAs for safety, yet there is no way to claim for them. If they undershoot, they will face penalties. Despite the assurances in Committee, the contracts that have emerged appear to allow for the tailing off of services towards the end of a year and for some jockeying to approximate as closely as possible the target number of UDAs. There is a parallel in the way in which PCTs finesse hospital treatment when funds run out at the end of the financial year. That is no way to manage patients.
	Ministers claim that the new contract will encourage a more preventive, health-promotion focus. How will that happen when the cost of the band 1 episode on which Ministers rely for health promotion will be at least twice the current cost? Nothing in the contract rewards the use of dental hygienists, whose services may become the preserve of private patients. I am sure that that was not the Minister's intention last year when she opened the school for complementary professions to dentistry in Portsmouth, which I had the pleasure of visiting last week.
	Several dentists have written about the perversities that the Government's interpretation of the Cayton report introduced. Earlier, we heard the Minister's explanation of the difference between the Cayton report and what we are now offered, and the extraordinary 40 per cent. uplift. Perhaps the Under-Secretary will expand on precisely what the Minister meant in her justification of the difference.
	We know that the cost of a basic filling will increase substantially and that a mouthful of fillings will cost the same as one. Clearly, the articulate and well-briefed patient will be able to obtain several items at once from band 2 while those who are less adept at using the system may lose out. There will be a tendency for dentists to offer simpler and quicker treatments in band 2 and only the guileful patient will be capable of pushing for more. Inevitably, that will widen oral health inequalities.
	Doubtless the Government will continue to blame previous Governments, local health care managers and practically anyone else they can think of for the chaos over which they preside. An insightful dentist wrote to me earlier this year. He said:
	"I believe you are after information about how the government are making a complete shambles of this new NHS dental contract."
	That is quite right. The writer continues:
	"What tickles me is, after 7 years, they are still trying to blame the previous Tory government. That's a bit like blaming potholes in the roads on the Romans."
	The hon. Member for Carlisle (Mr. Martlew) might like to note that point.

Eric Martlew: Will the hon. Gentleman give way?

Andrew Murrison: Oh good gracious me. Yes, I will.

Eric Martlew: I hope that the hon. Gentleman will not get too excited. Will he admit that closing two dental schools was a mistake by the previous Conservative Government?

Andrew Murrison: I am delighted that the hon. Gentleman rose to that cue. Does he seriously suggest that a decision that the university grants committee made 19 years ago is germane to the argument today? I do not think so—let us knock that one on the head. The debate is not only about the number of dentists—the hon. Gentleman knows that full well—but about how they are employed. The contract will make the position substantially worse and that is the reason for the debate.
	The catalogue of disillusion and dissatisfaction continues. A husband and wife dental team in the midlands wrote:
	"We are now . . . having to accept a contract that has not been fully piloted in its present form contrary to what the DOH keeps indicating. I could go into details but suffice to say I have never met so many colleagues that are disenchanted with the proposed contract and are considering cutting back or leaving the NHS in all the years since qualifying."
	There is more foreboding—I could go on and on, but time is short and I hope that the Under-Secretary will have something useful to say in a few moments.
	The accounts that we are receiving suggest that many dentists will sign up at the last minute as a stop-gap to allow them time to make plans, which will probably involve leaving the service. Concern about the systematic miscalculation of UDAs is a recurring theme of the correspondence that I received. The perception that the proposals will establish a new treadmill is one of the principal causes of dissatisfaction among NHS dentists. Sadly, that could have been ironed out if the new arrangements had been adequately piloted.
	In my five years as a Member of Parliament, I have never received so much correspondence or attended so many meetings about a single issue. One has to be pretty dedicated to the service to be an NHS dentist, given the attractions of more lucrative private work, yet the Government appear to have alienated them all. That is quite an achievement.

Liam Byrne: This has been a rich debate, and if a single theme has emerged from it, it is that there is a need for reform. So this debate, on the eve of the most significant reforms to dental services in the history of the NHS, is indeed timely.
	Important progress has been made in the provision of NHS dentistry since 1997. For example, there has been a 22 per cent. increase in the number of dentists in the system since then, from just over 16,000 in 1997 to about 20,000 in 2005. That is good news, but it is obviously not enough because many of them will not be working full-time in the NHS. Many of them will extend their private sector commitments rather than their NHS commitments, so we must take registrations into account as well. The number of registrations has gone up by 305,000 since 1998; it has increased in four of the six years for which we have records. The number of dental interventions has also gone up.

Martin Horwood: Will the Minister give way?

Liam Byrne: I need to respond to many valuable points, so I will not give way at the moment. If I have time nearer 4 o'clock, I will of course give way then.
	None of the increases that I mentioned has happened by accident. They have occurred because investment in NHS dentistry has risen substantially over the past few years. Indeed, it has gone up by 20 per cent., or £250 million, in the past couple of years. The Government have also recognised, however, that there are parts of the country in which an enormous amount more needs to be done. We therefore commissioned a report into the viability of the future work force, which in turn prompted our announcement of unprecedented investment.
	We have heard today that there is still an enormous amount to do, and the Minister of State set out a programme of reform that rests on three foundations. The first involves a new role for local health professionals working in primary care trusts to take a lead in commissioning services, and new arrangements to ensure that, when dentists leave the NHS, the money is recycled back into the NHS. From April this year, those health professionals will have the freedom to run budgets of about £1.7 billion. The second involves the big increase in the number of dentists being trained and recruited. The third is that we are seeking to change the relationship between the NHS and dentists with a new contract that will end the treadmill and encourage prevention. It will also encourage more dentists up and down the country to serve the NHS.
	The hon. Member for Mole Valley (Sir Paul Beresford) spoke with great insight and intelligence, as he always does on these matters, and I welcome his congratulations on some of the proposals that my hon. Friend set out. He said that the present system was not a treadmill. That was the opinion of one of his friends, but I think that the hon. Gentleman secretly believes that it is a treadmill. We must ask ourselves whether it is unreasonable for the NHS to agree to a certain amount of activity in return for writing cheques for £80,000 a year. Looking at the national picture, we shall be writing cheques for £2.3 billion worth of dental services, and it is not unreasonable to ask for a few specifics in return.
	The hon. Gentleman asked a number of important questions about whether there would be monthly targets and whether the PCT would be breathing down his friend's neck. There will not be monthly targets, and it is important to remember that the contract has been set in such a way as to ensure that dentists undertake 5 per cent. less work. It therefore represents a decisive move against the treadmill. We would, however, like to know the name of the hon. Gentleman's socialist dentist friend. Given what is happening, it will be important to ensure that his party membership is being paid by direct debit.
	The hon. Gentleman underlined the importance of the monitoring group that my hon. Friend the Minister of State announced, and I welcome his congratulations on that move. More broadly, NHS dentists, no matter who is in their chair, have to offer what is clinically necessary.
	The hon. Member for Totnes (Mr. Steen), who is not in his place, is an excellent advert for the hon. Member for Mole Valley. The hon. Member for Totnes did not say whether the treatment he received from his colleague was on the NHS, but in a thoroughly reasonable speech he highlighted concerns that underline the need for the reforms we are making—more investment, more recruitment and putting more people in training.
	The hon. Gentleman called for free care, but NHS care has not been completely free for some years, not even in Devon. The important point for him to pick up in Hansard is that the budget for NHS services next year will be ring-fenced. I think his PCT is Torbay, where there is a ring-fenced budget of £6.3 million for commissioning dental services next year.
	The hon. Member for North-East Milton Keynes (Mr. Lancaster) underlined the need for more dentists, which is an argument on which we would agree, but he should do more to challenge dentists locally who are refusing to register children. He questioned the number who might sign up to their contract by the end of the month. We shall see, as my hon. Friend the Minister of State said.
	We expect the vast majority of dentists to sign the new contract, and the point I would make to the hon. Gentleman about contract length is that contracts are a two-way deal. Many dentists do not want a contract of more than three years. Of course, the new general dental services contracts are an open-ended commitment, but the work that local health professionals will be doing in his area will be made substantially easier by the £8.2 million they will have to commission dental services next year.
	My hon. Friend the Minister of State was able helpfully to highlight a number of aspects of the contract, in particular the issue of the abnormal reference year, which was referred to by the hon. Member for Enfield, Southgate (Mr. Burrowes). He mentioned the example of a dentist who had taken maternity leave. She must take up the dispute resolution procedure with her PCT; it is important that she do so.
	I hope the hon. Gentleman accepts that it is not possible for my hon. Friend, formidable though she is, to negotiate every single contract personally. That is why she has to set a framework and rely to some extent on local professionals to operate within it. I should also say, if it is helpful to the hon. Gentleman, that my hon. Friend can sign and earmark the disputed clauses for later resolution.
	The hon. Member for The Wrekin (Mark Pritchard) made a number of points about listening to professionals. That is an important aspect that was highlighted in a document published yesterday, to which I shall refer in a moment, but, far from dentists not being listened to, the new system is virtually identical to that developed with the BDA two years ago. Far from blaming PCTs, we are putting more power in the hands of local professionals to negotiate local arrangements. What is more, they are doing a good job.
	In the hon. Gentleman's area, my hon. Friend tells me, there are new dentists arriving. He mentioned the centre that is opening just across the constituency border, where about 40,000 registrations will be available. That is part, I am glad to say, of a national pattern, and about 1,100 new dentists were recruited between April 2004 and April 2005.
	The hon. Gentleman made an interesting point. If I might be permitted a detour through the registration statistics under the last Conservative Government, he said that he is proud of that record, but I remind him that in the last four years under that Government registrations fell by 2.1 million.
	The hon. Member for Rochdale (Paul Rowen) highlighted the shortage of local dentists in his constituency—an issue that I think has been acknowledged. He made a number of points about the contract, the number of dentists in training and PCT responsibilities, all of which are incredibly important in taking things forward in his constituency. Rochdale's PCT has not one, but 20 NHS contracts and £4.3 million to commission services next year. He also criticised targets, but when we are writing cheques to a dentist for £80,000 it is not unreasonable to ask for a few things in return.
	My hon. Friend the Member for Carlisle (Mr. Martlew) spoke with great experience of health services. Usefully, he reminded us about our inheritance. He also reminded us helpfully of the struggles of living on £80,000. I extend my congratulations to his PCT, which is doing a good job locally. The fact that he has eight new dentists and 20,000 new registrations locally shows that progress is beginning to be seen in many parts of the country.
	My hon. Friend the Member for North-East Derbyshire (Natascha Engel) echoed the point about the need for reform and the lack of constructive criticism this afternoon. She was right to highlight the problems of shopping with toddlers, especially as one gets closer to the checkout. I have three children under the age of five, and I find that the only secure way of getting through a checkout is to put them in the trolley, where their little hands cannot reach through the bars. She made the important point that the reforms that we have introduced dovetail with a broader public health strategy.
	My hon. Friend the Member for Hayes and Harlington (John McDonnell), who, I am glad to see, has returned to his place, raised a number of important issues in an intelligent and thought-provoking speech. Where PCTs are wrestling with important issues, it will be of some comfort to know that money is ring-fenced for dentistry. He also raised the issue of the abnormal reference year. His PCT has the flexibility to discuss that in review with local dentists. As my hon. Friend the Minister of State said in reply to some interventions, dentists can sign contracts but mark disputed terms, which can be resolved later in dispute resolution. He wasright to underline the importance of the implementation group—

John McDonnell: It would be exceptionally helpful to the London dentists who have been meeting regularly if the Minister would consider a meeting with them to raise some of those general concerns.

Liam Byrne: I will pass that request on to my hon. Friend the Minister of State, and I am sure that she would be delighted to meet London dentists.
	The hon. Member for Falmouth and Camborne (Julia Goldsworthy) made a number of useful criticisms, although we did not hear much in the way of substance or constructive alternatives. I know that the ballot for the leadership of her party is taking place shortly, and I put on record my best wishes to all those candidates who remain in the field. I hope that whoever triumphs—if that is the word I am looking for—moves rapidly to fill in the blank sheet that he has been bequeathed.
	I suppose that I was looking for a slightly more forensic analysis from the hon. Lady. I know from the Electoral Commission's quarterly returns that the largest single donor to the Liberal Democrats in one quarter of last year was a company called Alpha Healthcare, so no doubt any future leader will be able to draw on a body of valuable expertise. She mentioned Birmingham, which I must mention as it is my home town. I got in touch with the Birmingham Mail yesterday, and in my experience it is right about most things. In the survey that it conducted of 175 dentists, between three and five dentists had definitively rejected the new contract—about 3.5 per cent. according to my maths. I look forward to progress over the rest of the month.
	The hon. Lady also spoke about dentists being insufficiently remunerated. Again, I do not think that £80,000 is bad.

Martin Horwood: Will the Minister give way?

Liam Byrne: I will plough on, because I must finish my response.
	I was slightly concerned that many of the concerns of the hon. Member for Falmouth and Camborne were riddled with misapprehension, not just about NICE guidance but about charging bands.
	That lack of substance was not echoed by the Conservative party, however, which has been producing many interesting press releases, speeches and pamphlets. I have one here, which has on it an excellent picture of the hon. Member for South Cambridgeshire (Mr. Lansley) looking thoughtful. It is called "Built to Last", which is a phrase that might acquire some interest. It was published yesterday, and set out some important principles. Principle four was that public services for everyone must be guaranteed by the state—hear, hear. Principle one, however, was that the proceeds of growth will be shared between public services and low taxes. It will be interesting to see how the tension between those two points is played out.
	I will not dwell on the fact that it was the Conservative party that cut fees by 7 per cent., or on the fact that registrations under it fell by 2.1 million. We have already heard about the closure of two dental schools, but I think it important to note the analysis behind that decision. At the time, the then Secretary of State for Health said that there would be a possible serious oversupply of dentists in the future unless the present rate of students admitted was reduced. Given that analytical foresight, I am not sure that "built to last" is the right phrase.
	While we are cutting the work load, the Conservatives would cut wages. While we are opening dental schools, they would close the doors. I commend the amendment to the House.

Question put, That the original words stand part of the Question:—
	The House divided: Ayes 222, Noes 287.

Question accordingly negatived.
	Question, That the proposed words be there added, put forthwith, pursuant to Standing Order No. 31 (Questions on amendments), and agreed to.
	Mr Deputy Speaker forthwith declared the main Question, as amended, to be agreed to.
	Resolved,
	That this House welcomes the Government's Oral Health Plan for England, which builds on major oral health improvements in the last 30 years, and the additional £368 million for improving dental services in England announced in July 2004; recognises the Government's substantial achievements in improving the short and longer term supply of dentists for the NHS including recruiting the equivalent of an extra 1,459 whole-time dentists between April 2004 and October 2005, compared to the 1,000 extra dentists promised, and funding an additional 170 training places; further recognises that the Government is investing £80 million in improving dental school facilities, and has approved the establishment of a new dental school in the South West Peninsula; notes that the total number of primary care dentists in the NHS had increased to more than 21,000 by the end of October 2005, compared with 16,700 in 1997; further welcomes the reduction in the maximum patient charge from £384 to £189 from 1st April; further welcomes the new ways of working tested through Personal Dental Services pilots; supports the framework for new dental contracts which will free up significantly more time to provide preventative care, remove the requirement for NHS dentists to treat patients on a fee for service basis and ensure that a committed NHS dentist can expect to earn on average around £80,000 a year; and further welcomes the fact that, where dentists do not take up new contracts, primary care trusts will commission replacement services from other dentists.

Cancer Services

Mr. Deputy Speaker: We now come to the second debate on an Opposition motion. I must inform the House that I have selected the amendment in the name of the Prime Minister, and once again placed a 10-minute limit on speeches by Back-Bench Members.

John Baron: I beg to move,
	That this House recognises that there have been improvements in the provision of cancer care due to the extra investment in the NHS and the hard work and dedication of NHS staff; but notes that a different approach is now needed to raise standards of treatment throughout the entire patient pathway to the best levels achieved in other European countries; believes that more should be done to end the postcode lottery in drugs and treatments; wishes to see more done to raise awareness of the risk factors and symptoms of cancer; further believes that cancer is increasingly a long-term condition and that there should now be a greater recognition of the importance of quality of life issues; and calls on the Government to give the National Institute of Health and Clinical Excellence a much stronger role in establishing holistic standards and entitlements to care covering the entire patient pathway.
	No one can doubt the significance of cancer to many millions of people in this country. The disease remains one of the biggest killers in the UK, accounting for approximately a quarter of all deaths and claiming more than 150,000 lives a year. More than one person in three will be diagnosed with cancer at some point in their lives, and there is likely to be a significant increase in the number of new cases over the next few years, partly due to our ageing population structure.
	Given its importance, I hope that this debate about the future of cancer services can be constructive. I, for one, recognise that improvements have taken place under this Government, but I shall also highlight the fact that there are still failings in the system, in the hope that they will be recognised and put right.
	The Government's amendment runs the risk of appearing somewhat complacent. It is full of self-congratulation, and mainly looks back at the past. Putting that to one side, however, I accept that it would be churlish not to accept that the Government have made extra funding available and that improvements have been made. It is not often that a shadow Minister quotes good figures on the Government's behalf, but one example of those improvements is that, whereas only 42 per cent. of patients diagnosed with colon cancer in the first half of the 1990s survived for five years, that figure had risen to 50 per cent. by the start of the present decade.
	Naturally, Opposition Members congratulate staff in the NHS and the voluntary sector on their hard work and dedication to patient care, which have helped to bring about the improvements in outcomes. Those improvements are welcome, but they are not exceptional when compared with the long-term trends that date back to the 1980s.

Howard Stoate: Will the hon. Gentleman give way?

John Baron: I intend to make some progress, but I assure the hon. Gentleman that I will give way in a little while.
	According to figures produced by Cancer Research UK, mortality rates fell by 11 per cent. between 1988 and 1997, and by 6.5 per cent. in the first six years after Labour came to power. I hope that the Secretary of State will not copy the Prime Minister's trick of using the mortality figures since 1997 as proof of the effectiveness of the Government's cancer strategies. There has been no marked improvement in the overall trend going back to the 1980s, despite the extra funding.
	The Government use more selective figures in their amendment, but even they cannot disprove our case. Although there has been a 14 per cent. fall in mortality figures since 1996, the total death rate for people under 75 years of age also fell by 14 per cent. in the final nine years of the previous Conservative Administration.
	The Opposition recognise that there have been improvements in outcomes, but they have not outstripped comparable improvements in continental survival rates. According to last year's report from the Karolinska institute, the UK still lags behind other European countries when it comes to survival rates over periods of one year and five years. In fact, Britain has one of the worst survival rates in all of western Europe: whereas 81 per cent. of cancer patients in France survive for one year, the equivalent UK figure is only 67 per cent. Even Albania and Lithuania have better one-year and five-year survival rates than we do. Estimates suggest that more than 20,000 lives a year could be saved each year if the NHS met the best European standards of care.
	Meanwhile, the outcomes gap between rich and poor people in the UK is also unacceptable and getting wider. A recent report from the Public Accounts Committee highlighted persistent and unacceptable variations in outcomes, depending on where patients lived. Breast cancer death rates are 20 per cent. higher in some northern regions than they are in other areas, mainly in the south of the country.
	Those are unfortunate facts, but whether cancer services are equipped to meet the fresh challenges that we face is also open to question. For example, more cancer patients are now living longer, which means that, increasingly, the disease must be regarded as a long-term condition. The emphasis of policy in the future must shift from getting patients into the early stages of treatment as quickly as possible, important though that is, to ensuring that later stages of care, information and emotional support are widely available. To achieve that, several failings need to be addressed.

Howard Stoate: I am grateful to the hon. Gentleman for acknowledging that services are improving. Does he agree that the most difficult time for any patient with a possible cancer diagnosis is the early stages of waiting for a diagnosis? Will he therefore join me in congratulating the NHS on reaching the target of ensuring that almost every patient whom a GP suspects may have cancer is seen within two weeks by an NHS specialist? The initial tests can be done quickly to reduce the awful burden of anxiety faced by someone in that position.

John Baron: I take the hon. Gentleman's point, but he refers to early referrals. The problem is that far too many women are diagnosed with cancer after being referred on a routine, non-urgent basis. It could be argued that the two-week target has distorted clinical priorities. Breakthrough Breast Cancer has made that case many times.

Iris Robinson: My mother was diagnosed with breast cancer and had a mastectomy, and I had quite a scare last September. Does the hon. Gentleman agree that the Government must take steps to ensure the correct analysis of mammograms? Radiographers have got that wrong in the past, but patients need to be assured that they receive the correct results. Does he also agree that herceptin should be given to the women who need it, and that we should not have a postcode lottery?

John Baron: I completely agree with the hon. Lady and I will come to those points later in my speech.

Sadiq Khan: The hon. Gentleman compared the UK with European countries with better success rates, but does he agree that we have seen improvements over the past eight years? In 1997, Labour was the first major political party to mention the word "cancer" in a manifesto. In 1997, we had a Green Paper that set a target on death rates for 13 years' time and, in 1999, for the first time, a directorate was set up to deal with cancer. Again for the first time, in 2000, we had a 10-year plan to fight cancer. Is it not the decades of neglect that have led to the problems that the hon. Gentleman mentions?

John Baron: I suggest to the hon. Gentleman that there is no point just talking about cancer—we want action, and we are trying to look forward in this debate. As I said earlier, there have been no marked improvements in mortality rates, despite all the money that has gone into the NHS. The Government can produce as many papers as they like, but what we need are improvements on the ground.

Bob Spink: My hon. Friend is right to talk about the need for action. Does he agree that long-term survival rates could be greatly improved if everybody had proper access to the most appropriate and up-to-date medicines, without postcode prescribing? For instance, for high grade malignant brain tumours, we need to ensure that sufferers have access to temozolomide and gliadel implants.

John Baron: I agree with my hon. Friend and I shall address the issue of the postcode lottery shortly.
	One reason why the Government's additional funding for cancer services has not produced a marked improvement in the longer term mortality trend is that the two-week and one-month targets, to which the hon. Member for Dartford (Dr. Stoate) referred, have focused attention and resources on the front end of the patient pathway, to the detriment of the other end. The later stages of cancer care have been neglected as a result. The Government's targets may have been successful in getting more people into the system more quickly, but staff shortages have created bottlenecks further down the line. Radiotherapy offers an example.
	The importance of radiotherapy is that more than half of all cancer patients will undergo it at some stage of their treatment, yet in January a report in the British Medical Journal observed that pressures on cancer units across the UK have led to longer waits for radiotherapy patients and may be reducing chances of survival.
	High staff vacancy rates are causing real concern. In evidence to the pay review body, the Society of Radiographers noted that vacancy rates for therapeutic radiographers in England stood at 17 per cent. There is a particular shortfall of experienced, specialist radiographers. The Government may have increased student numbers, but new graduates do not possess the skills needed to fill that type of vacancy. According to the society, the current high number of vacancies and Government targets have made managers reluctant to release existing staff for further training opportunities, so it does not look as though the situation is getting better. As a result, waiting times for radiotherapy have lengthened since 1997. According to figures collected by the Royal College of Radiologists, radiotherapy waiting times in 2005 were worse than those documented in 1998; for example, whereas in 1998, 32 per cent. of patients in need of radical radiotherapy waited longer than the recommended maximum of four weeks, by 2005 the figure had grown to 53 per cent. More than half of all patients receiving curative radiotherapy now wait longer than the recommended maximum of four weeks.
	For their part, despite a recent assurance at Health questions that hidden waits would be measured, the Government have insisted that no official monitoring of radiotherapy waiting times will take place. That is a great shame. I put it to the Secretary of State: how can the Government hope to resolve the serious problems in radiotherapy if they have no official idea of the extent of the problems because they are unwilling to collect the statistics? Although I wrote to the Secretary of State about the issue after our exchange at Health questions in January, I am still waiting for a response.
	Radiotherapy is not alone, however. There are similar problems for other treatments. According to the Dr.   Foster organisation, there has actually been an upward trend in waiting times for surgery for the 10 most prevalent cancers since 2001. Meanwhile, according to research cited in a report by the cancer capacity coalition, a number of clinical directors expected rising demand for chemotherapy to lead to longer waiting times over the next five years.
	Things must change. The Opposition believe that one solution to the problems would be to move away from targets, which distort clinical priorities by focusing resources on the front end of the patient pathway, and to instruct NICE to draw up standards and entitlements for patients covering the entire pathway—a point to which my hon. Friend the Member for Castle Point (Bob Spink) referred. In other words, we should shift entirely the emphasis for cancer care from politicians dictating targets for patients to patients having entitlements to standards of care decided by medical professionals; the entire journey should be covered, including the later stages of treatment such as radiotherapy. Such an approach directly recognises the fact that there is no use in getting more people on to the patient pathway sooner if we do not ensure their access to all stages of life-saving treatment.

Andrew Turner: Does my hon. Friend accept that an important component of radiotherapy is being able to access the service? It is recognised by authorities that stress and concern about travel arrangements affects people's ability to benefit from radiotherapy. Will he congratulate the Isle of Wight council on announcing that it is making £50,000 available from its budget this year to fill the shortfall caused by the NHS withdrawing funding for radiotherapy patients to cross the Solent for treatment in Southampton?

John Baron: I do not know the details but it sounds as though the local authority has done a good job and I duly congratulate it.

David Tredinnick: My hon. Friend mentioned that survival rates are low. Is not one of the weaknesses of the Government's strategy that not enough has been done to support cancer sufferers? Not enough attention has been paid to the work of the Bristol Cancer Help Centre or the cancer lifeline kits that are available, which offer a range of supporting therapies and address things such as diet, detoxification, relationships at home and even spiritual issues. The Government have missed those soft targets.

John Baron: My hon. Friend will remember that I attended one of his meetings on this issue, and I agree that we need to consider providing much wider support—

Mr. Deputy Speaker: Order. I am sorry to interrupt the hon. Gentleman, but when he turns away to address his hon. Friend, he should bear in mind that he should be addressing the Chair and that it is also important that he should address the microphones, otherwise, it creates a problem for Hansard.

John Baron: I appreciate that guidance, Mr. Deputy Speaker.
	The short answer is that I agree, but I shall make some progress.
	Let me turn to access to drugs—another area where cancer services should be doing much better. We have the best cancer research record in Europe but among the poorest uptake of new drugs, as recently confirmed by the Karolinska report, which identified that the UK was consistently below average in adopting new drugs for the treatment of breast cancer, colorectal cancer and lung cancer. The reasons for that are varied. First, the NICE process has been too slow. Delays have meant that English patients have been forced to wait for approval, even though patients in Scotland and the rest of Europe have sometimes received their drugs more quickly.
	Last year, CancerBACUP identified 23 cancer drugs that were subject to delays after NICE's budget was cut and the number of appraisal committees was reduced from three to two. Since then, some reform has taken place, and we support it. However, the success of the new single technology appraisal should not be won at the cost of other drugs going through the standard procedure more slowly. Ultimately, if NICE is to meet the growing demand for new drugs, it should be provided with the resources that it needs to support three appraisal committees.
	Another problem is that, although NICE was set up to tackle the postcode lottery in drugs throughout the country, its guidelines are subject to postcode lotteries—a fact recognised by the cancer tsar, Mike Richards, in his report two years ago. More recently, the Public Accounts Committee report confirmed that, one year after NICE approval, the use of herceptin for breast cancer ranged across cancer networks from 90 per cent. to under 10 per cent. of eligible women.
	For one bowel cancer medicine—eloxatin—independent research found that more than one in four consultant oncologists were not able to implement new NICE guidance in the 90-day implementation period. Those clinicians cited the lack of funding as the main reason, despite the Government's extra investment in the NHS. Such regional variations must end.
	The Opposition believe that we have a system that is essentially unfair. There is an inherent inequity in the system in gaining access to drugs. The postcode lottery for the availability of drugs can only be eradicated if NICE is asked to carry out full resource implementation assessments alongside its appraisals for cost and clinical effectiveness. That will help to ensure that aspirations contained in the guidance become a practical reality. The guidance will be realistic because the decisions have been costed.
	Nowhere has the controversy over access to drugs been fiercer than over the funding of herceptin for early-stage breast cancers. The intervention by the Secretary of State for Health last October, when she suggested that PCTs should not withhold the drug for reasons of cost alone, has added to confusion about patient entitlement to unlicensed drugs. Inadvertently, the right hon. Lady raised the hopes and expectations of women with HER2 positive breast cancer that they would have access to that drug, but those hopes were crushed by the High Court ruling last month. If her original remarks at the Breakthrough Breast Cancer fly-in did not sufficiently create the impression that eligible women should expect primary care trusts to fund herceptin where a clinician was prepared to prescribe it, her subsequent decision to challenge North Stoke PCT certainly did. Now, there is still a postcode lottery in the prescribing of herceptin for early-stage breast cancer, as PCTs come to different decisions about the drug. That was the danger in the Secretary of State pre-empting NICE.

Ian Liddell-Grainger: My hon. Friend is well aware that the condition of the lady who fought for the drug—Barbara Clark, who is one of my constituents—has now got worse, because its use has been okayed for late-stage cancer but no one can decide when a patient's stage changes from early to late. The postcode lottery is all right if someone is late-stage, but there is still a battle. Wales has just announced that it will stop the lottery, so has Scotland. Only England has the problem. Does my hon. Friend agree that that is a farcical position for us to find ourselves in?

John Baron: I completely agree. It is simply farcical that we have got ourselves into this position and it is does not look as though the situation will get better. Unless we make the recommendations to NICE that we have suggested, there will continue to be a postcode lottery and many patients will suffer as a result.

Howard Stoate: It is impossible for NICE to make a decision on early-stage breast cancer because, as the hon. Gentleman knows, Roche only applied for a licence for herceptin in the past few days. Is he as dismayed as I am that Roche has been so slow in pushing for a licence for a drug that American studies have shown to be so useful?

John Baron: The key question is: on what basis should herceptin be available now? The Secretary of State has caused confusion by intervening and overruling NICE. Primary care trusts are in a very difficult position. Some, like Swindon, will have the option of not funding herceptin if they can demonstrate doubts about its safety or clinical effectiveness. However, the PCTs that have decided to fund herceptin for early-stage breast cancer on the back of the right hon. Lady's intervention find themselves in a difficult situation. Although many trusts are struggling with deficits, the Secretary of State has not made special funding available. Local health managers face the unwelcome task of diverting funding away from other services, including those for other cancer patients, to action a political instruction from Government half way through the financial year.
	It is no surprise that Pamela Goldberg, the chief executive of Breast Cancer Campaign, has said—I hope the House will forgive me for citing her comments, but they provide a powerful illustration of the situation—that the intervention
	"has caused more anxiety and confusion than clarifying the situation. Unless financial resources follow this sort of intervention we will see a situation where patients will be forced to challenge decisions on an individual basis. Primary Care Trusts have been put in a very difficult situation with their budgets already stretched to capacity."
	If the point of the Secretary of State's intervention was to end the postcode lottery for herceptin, where is the evidence that that has been achieved? If it was not designed to do that, will she explain to the House what the point of her intervention was?

Steve Webb: The hon. Gentleman is making a measured contribution, but is he saying that, if he were the Secretary of State for Health, he would ask NICE to appraise unlicensed drugs, or that he would require PCTs to pay for herceptin and would provide central funding for that?

John Baron: There are a number of issues, one of which is transitional funding. As soon as drugs become licensed, they should be appraised. The fast-track process should apply in this case. If we continue with the current system, the postcode lottery will inevitably follow. We must sort the situation out and the only way in which we can do that is by making sure that there is an appraisal process as soon as a drug is licensed and that full resource implementation takes place in tandem.

Michael Wills: I want to clarify one point about the hon. Gentleman's attitude to the postcode lottery. He has been eloquent about how much he disapproves of it, but how does that square with his leader's much-vaunted commitment to localism?

John Baron: The hon. Gentleman is getting confused. At the end of the day, there is no doubt that if we aim to end the postcode lottery and have fairness in access to drugs throughout the NHS, there must be national standards and national appraisals. The bottom line is that there is a fundamental difference between standards and targets. Obviously, he has not taken that up. I am going to try to make some progress.

James Gray: Before he does, may I ask my hon. Friend whether he is not simply astonished that the hon. Member for North Swindon (Mr. Wills), in making his intervention, did not mention his constituent, Anne Marie Rogers, the lady whose request for herceptin was turned down by Swindon PCT? Is not that odd? Is the hon. Gentleman saying that he likes local decision making that goes against his own constituent?

John Baron: My hon. Friend makes a valid point.

Michael Wills: rose—

John Baron: The hon. Gentleman should sit down. He had his go and he blew it; he did not make a worthwhile contribution. I shall try to make some progress.
	I want to focus on the importance of detecting cancers early, which is vital in giving patients the best possible start to treatment. The Government's record in this area, too, is mixed. The Public Accounts Committee report highlighted the fact that a public awareness campaign on the signs and symptoms of cancer due in 2001 has still not been fully implemented. As a consequence, the report claims:
	"Patients are diagnosed with cancer at a later stage in the UK than in other European countries and this particularly affects people from deprived areas in England."
	A more active policy is clearly needed.
	With regard to cancers in general, as part of its new role in public health, NICE should be involved in drawing up a full, evidence-based communications campaign on the signs and symptoms of cancer to encourage patients to present earlier. But if patients are going to present earlier, and in larger numbers, GPs, many of whom see only a handful of cancers each year, clearly need improved guidance on referral. According to the National Audit Office, only about half of GPs surveyed had seen departmental guidelines on spotting cancers and found them useful. That needs to be put right.
	Screening, too, has an invaluable role to play in catching cancers early, but again much more needs to be done. The success of the NHS breast screening programme, introduced in 1988, clearly demonstrates how catching cancers early can save lives, and I look forward to the day when other cancers can be detected in this way. On bowel cancer screening, for example, we welcome the Government's commitment to roll out a national programme from April, but why are Ministers now obfuscating about funding?
	In October 2004, the then Secretary of State made a commitment to fund the programme to the tune of £37.5 million over two years, but now the programme is said to be subject to budgetary considerations. Perhaps this Secretary of State will explain to the House what has happened to that allocation. Is bowel cancer screening now to become the latest victim of NHS deficits?
	Perhaps the right hon. Lady will also explain why her Department has been so coy when asked about the future of the programme. The charities Bowel Cancer UK and Beating Bowel Cancer hand-delivered a letter to the Department on 13 December last year, inquiring about plans for national screening. However, only last week, in reply to my parliamentary questions, did Ministers acknowledge the existence of the letter and promise to reply. That really is not good enough. Bowel cancer appears to be one of the poor relations among cancers, and that needs to be put right, if only because it kills about 17,000 people a year.

James Clappison: As my hon. Friend will know, this country is lagging way behind western Europe and north America in bowel screening. Has he noticed that in the Government's amendment to the motion there is no mention at all of bowel screening? Does he agree that the House would look forward to a full explanation from the Secretary of State of what the Government plan to do on that?

John Baron: I do agree. As I said, bowel cancer is the poor relation among cancers, and that has been demonstrated by the lack of response from the Department on some of the issues that various charities have raised about the screening programme. I hope that the Government will shortly put that right.
	On prostate cancer, various studies have cast doubt on the effectiveness of the prostate-specific antigen test, which is why we have called on the Government to give leadership to international efforts to find a reliable test for this disease, which kills almost as many men in the UK each year as breast cancer kills women. In the meantime, the prostate cancer risk management programme supports GPs in offering men an informed choice about PSA testing. However, many GPs are not even aware that support tools exist. That, too, needs to be put right.
	So far we have discussed improving survival rates, but there is also a need to transform the quality of life of cancer patients. There needs to be better recognition by Government that, because more patients are living longer with cancer, cancer needs to be treated as a long-term medical condition. Patients should be given support to manage their own care as much as possible and to make informed choices about treatments where appropriate. Access to information is crucial for people living with cancer and is vital if patients are to be put in the driving seat. Yet communication issues continue to be a common cause of complaint for people with cancer.
	According to the recent Public Accounts Committee report, one fifth of patients are not made fully aware of the potential side effects of treatment. About 40 per cent. of cancer patients were not informed about cancer support or self-help groups. As well as emotional support, patients should also receive, as a matter of right, information about entitlements to benefits.
	According to Macmillan Cancer Relief, three quarters of patients do not receive such advice. The last thing that patients undergoing treatment require is to have to worry about not paying bills because of low uptake of benefits to which they are entitled. Another failing of the system is that it does not adequately address what I call the black hole between health and social care, into which too many patients fall without the care and treatment that they need. The gap needs to be bridged. That is why individual needs should be assessed on a holistic basis with professionals and health andsocial care staff working together through multidisciplinary teams.
	Specialist clinical advice and support is also extremely important. Currently, Britain has too few specialist cancer nurses. We believe that NICE should be instrumental in drawing up holistic standards and entitlements to care that address the emotional and information needs of patients throughout the entire patient pathway, and so bridge the gap between health and social care. These standards would be for the whole journey, including, perhaps, giving patients the right to die at home if they so wish.
	These standards should also be enforceable. One way of achieving that would be for clinical guidelines to be the basis of contracts between NHS commissioners and providers. In short, we should aim to create a culture of entitlements to care. For example, we on the Opposition Benches are increasingly attracted to the idea of an information prescription given by GPs or specialist nurses—I am pleased to say that the Government are picking up on this—as the starting point of patient empowerment. Expertise in meeting these challenges and improving the quality of patient care already exists in the voluntary sector, and should now be harnessed by the NHS in meeting more robust professional guidelines set by NICE.

Jeremy Wright: On the subject of NICE, my hon. Friend will be aware of the arguments that relate to Alzheimer's drugs. I ask him to consider whether those arguments should apply also to cancer drugs. Should not NICE consider the economic impact on social services as much as on health services when considering the economic viability of cancer drugs?

John Baron: In short, we very much agree with that. That is one criticism of the decision involving Alzheimer's drugs, in that it concentrated on health costs and benefits. The decision should have focused also on social costs and benefits, so as to bridge the gap. Cost savings could then be made with the provision of good standards of care in viewing the whole journey to the end, as it were. That is one of the faults of the system at present. It is focused too much on health and we need also to consider social care.
	Reducing inequalities of outcome is not only a matter of improving survival rates. The battle against cancer must increasingly be fought by increasing awareness of risk factors and influencing lifestyle choices. This is the importance of prevention. Smoking is by no means the only risk factor that is associated with cancer. We must now put the focus on factors such as obesity, which causes about a third of all cancer deaths. Mesothelioma affects a new generation that are not aware of the risks of asbestos. They are embarking on potentially dangerous do-it-yourself renovations of old buildings, for example. There is a need for better warning about this deadly disease. These facts can be used powerfully to argue for a much better public health and awareness campaign to tackle health inequalities. We as a party were pledged to put these themes at the heart of our policies if elected last year.
	As part of its new public health role and alongside communication campaigns on the symptoms of cancer, we believe that NICE should be involved in drawing up an evidence-based awareness programme of how people can alter their lifestyles to reduce risk.
	The present situation is unacceptable. Despite extra investment and some improvements, Britain's cancer survival rates are still among the worst in Europe. The Government's targets focus on the front end of the patient pathway to the detriment of the latest treatments, which have been neglected. Waiting times for radiotherapy, for example, have undoubtedly increased, but the Government refuse to monitor the situation. There is still a postcode lottery in access to drugs, with British patients benefiting from new treatments later than their European counterparts. Guidance from the National Institute for Health and Clinical Excellence on technologies and standards of care has not been universally implemented.
	The Secretary of State's intervention over herceptin unfairly raised the hopes of women with early-stage breast cancer. By failing to make specific funding available, she has put primary care trusts in an impossible situation, and she has disappointed patients. Meanwhile, services have not yet fully recognised that cancer is increasingly a long-term term condition, and should be treated as such. The black hole between health and social care needs to be addressed. In future, decisions about cancer services should be taken as much as possible by clinical experts from NICE, rather than by politicians in Whitehall.
	The NHS has been a political football for too long. It is time for politicians to step back, and allow the medical professionals to get on with the job. NICE should take on a much more ambitious role in drawing up guidelines on entitlement to care. Those standards should take account of patient needs on a holistic basis, including the need for information and emotional support, and they should join up health and social services effectively. Standards must cover the entire patient journey from prevention and awareness to the later stages of curative and palliative care and, like technology appraisals, they should be enforceable. To end the postcode lottery in access to drugs and treatments, NICE guidance appraisals and recommendations should be made alongside resource implementation assessments so that national guidance is realistic and successful, enabling us to end the unfairness inherent in the system.
	In short, it is almost a crime that, despite a massive increase in funding, cancer services still lag behind their European counterparts. We need an ambitious programme for the future of cancer services and a fresh approach that puts patients in the driving seat by providing them with an entitlement to standards of care, as decided by medical professionals, not the politicians; by raising treatment standards throughout the patient pathway; and by recognising quality-of-life issues, which are important to patients. For those reasons, I urge the House to support the motion.

Patricia Hewitt: I beg to move, To leave out from "House" to the end of the Question, and to add instead thereof:
	"recognises that the Government has made the improvement of cancer services a key priority through the implementation of the NHS Cancer Plan which sets out to reorganise and rejuvenate cancer services and has provided the NHS with investment to modernise these services; welcomes the achievements set out in the recent Public Accounts Committee report, the NHS Cancer Plan: a progress report, which acknowledged that significant progress has been made across the country; notes that the total death rate for cancer in people under 75 has fallen by 14 per cent. since 1996; acknowledges that under this Government unprecedented investment in equipment is helping to improve both access to, and reliability of, diagnosis and treatment; further notes that specialist teams have been established across the country to help deliver co-ordinated care to patients in hospitals; further welcomes the fact that the National Institute for Health and Clinical Excellence is introducing a new fast track assessment process to enable them to issue binding advice to the NHS on the most important new drugs within weeks of them receiving a licence; further notes that this Government has commissioned research to enable initiatives to raise awareness of the symptoms of cancer to be targeted on people most at risk; further notes that there has been a 43 per cent. increase in cancer consultants since 1997; acknowledges that there has been a 40 per cent. increase in cancers detected through breast screening; and further welcomes the Government's commitment to continuing to deliver the commitments in the NHS Cancer Plan."
	I welcome the opportunity to debate the future of cancer services. I welcome, too, the way in which the hon. Member for Billericay (Mr. Baron) opened the debate and the tone of much, if not quite all, of his comments. I particularly welcome his recognition that we have made significant improvements in the care of cancer patients in the past eight or nine years.
	The death yesterday of the wonderful Linda Smith from ovarian cancer reminds all of us again of the terrible toll of cancer—over 4,500 deaths each year from ovarian cancer alone. This evening, many hon. Members, particularly Conservative Members, will attend an event to celebrate the life of Gregor MacKay. Gregor worked as press secretary to the right hon. Member for Richmond, Yorks (Mr. Hague) when the right hon. Gentleman was Leader of the Opposition, but he had many friends across the political divide. He died last year aged just 36, only eight weeks after being diagnosed with lymphoma. I wish the lymphoma research fund that will be launched this evening in Gregor's memory every success, and I am sure that Opposition Members will wish to join me in doing so. There is hardly a family in the country that has not been affected by cancer in one way or another. It is one of the highest priorities for the national health service, and we have made it so.

Mark Francois: Cancer is an emotive issue, not least in south-east Essex, where a consultation is taking place about reconfiguring networks. The south Essex cancer network was given a special dispensation below the 1 million people threshold because we have a higher than average proportion of elderly people, who are unfortunately more likely to suffer from the disease. The network is popular and successful. Its headquarters are at the cancer centre at Southend hospital, which I am pledged to defend, as are other local MPs from south-east Essex. The network works and the centre is popular—it is not broken and we do not need anybody to fix it. Will the Secretary of State bear that in mind and look sympathetically on it?

Patricia Hewitt: The hon. Gentleman makes extremely important points which he and his hon. Friends are also making in the local consultation. Those decisions are best made locally, but I am sure that his comments will be fully taken into account.
	In 1997, we set a target to reduce the death rate from cancer in people under 75 years old by 20 per cent. by 2010. I pay tribute to the work of the then Minister for Public Health, my right hon. Friend the Member for Dulwich and West Norwood (Tessa Jowell), who was instrumental in making that commitment in the public health Green Paper. The year after that, we set the target that every patient referred by a GP with suspected cancer would be seen by a specialist within just two weeks.
	In 1999, we appointed the first national director for cancer, Professor Mike Richards, whom I thank for his outstanding clinical leadership on this issue. I find it extraordinary that the hon. Member for Billericay scorns political decision making, given that we have done so much to ensure that as we set targets and improve services, we do so on the basis of the best clinical advice and outstanding clinical leadership.
	In 2000, again with the full support and involvement of leading cancer specialists, patients' groups and academic experts, we launched the first ever national cancer plan. As a result, we began an unprecedented programme of investment in cancer services, with an additional £639 million extra in the past five years. We have used that investment to train and recruit new cancer specialists, so that we now have nearly 1,400 more cancer specialists in the national health service than we had in 1997.

Owen Paterson: If we have a national plan, could the Secretary of State explain to my 10-year-old constituent, Katie Morgan from Wixhall, why her mother, Susan Morgan, and another constituent, Mrs. Margaret Bradford, are today at a public meeting in Shrewsbury trying to raise money for a £47,000-per-person herceptin treatment although that treatment is available two miles away in Wales and 10 miles away in Staffordshire? If we have a uniform comprehensive tax system, as the hon. Member for North Swindon (Mr. Wills) said, why do we not have comprehensive provision of this life-saving drug? Mrs. Morgan has been told by the PCT: "Your circumstances are not exceptional." Yet this is a death-dealing disease.

Patricia Hewitt: I shall come to that issue in due course. I would be grateful if the hon. Gentleman would wait until I do so, because I want to deal with it in some detail.

Sadiq Khan: My right hon. Friend will have heard hon. Members cherry-picking from the progress report on the Government's NHS cancer plan by the Public Accounts Committee, which is excellently chaired by the hon. Member for Gainsborough (Mr. Leigh). Far be it from me to engage in political point-scoring, but will she comment on that report? It said:
	"Across the country significant progress has been made in improving cancer services and managing them more effectively, in particular, speeding access to cancer diagnosis and treatment."

Patricia Hewitt: My hon. Friend is right to draw attention to that valuable report, particularly its commendation of the significant improvements that have already taken place. Obviously we will respond to it in detail in due course.

Mark Lancaster: I am sure that the Secretary of State will join me in acknowledging the good work of the Neuroblastoma Society, even though she said in a recent written parliamentary answer that she will not offer it any support. If such great improvements have been made, will she explain to my five-year-old constituent, Isobel Sanders, why, on 9 May last year, two of the eight specialist paediatric oncology beds were closed in the Thames Valley strategic health authority because of staff shortages and why not a single bed in England and Wales was available to take her?

Patricia Hewitt: I am extremely sorry to hear about what must have been a desperately anxious and agonising predicament not only for the hon. Gentleman's young constituent but for the entire family. I do not know the background to the decision, but such decisions are rightly made by hospitals, primary care trusts and strategic health authorities in local areas. I believed that that policy was supported by hon. Members of all parties. However, I greatly hope that the hon. Gentleman's constituent has received the treatment that she needed.
	I am sure that all hon. Members want to thank our superb cancer staff in the NHS. Thanks to their dedication—backed by our investment—deaths from cancer have fallen by 2 per cent. a year in people under 75 and decreased especially quickly for men who suffer from lung cancer and for women with breast cancer. We are well on course to achieving the target that we set of reducing the death rate from cancer by 20 per cent. by 2010. Already, 43,000 people's lives have been saved.
	The hon. Member for Billericay referred to survival rates. We should all be proud of the improvements in survival rates, although of course they are not yet good enough. In 1970, a woman with breast cancer had a 50 per cent. chance of survival. Today, the figure exceeds 80 per cent. In 1970, a patient with bowel cancer had a 25 per cent. chance of survival. By 2000, the figure was 50 per cent. Genuine improvements have therefore occurred.
	I agree with the hon. Member for Billericay that cancer does not have to be a death sentence. It is increasingly a long-term condition. More and more people—some of them relatively young—are living with cancer and after cancer. They will need continued, appropriate support.

Nick Hurd: On that point, convenient access to care becomes increasingly important. I hope that the Secretary of State is aware of the decision to close cancer services at Mount Vernon hospital from 2012. Is the best that the British Government can offer the million or more people in the west London cancer network, for whom that site is the most convenient, a journey time of an hour and a half on public transport for cancer care?

Patricia Hewitt: The hon. Gentleman knows that a review of services across north-west London is taking place. The proposal is part of that review and an appropriate consultation is under way. I am sure that his points will be taken into account.
	The aims of the cancer plan can be summed up very simply: prevent more, diagnose early and treat fast. I want to say something about what we have already done and what we must do on each of the three elements.
	We all know that smoking is the largest single cause of cancer deaths in the United Kingdom. The ban on smoking in enclosed public places, on which the House recently decided by an overwhelming majority, will be perceived as one of the landmark Acts in the protection of public health. It builds on our work on tackling tobacco smuggling, banning tobacco advertising, placing tougher warnings on cigarette packets, and our successful NHS smoking cessation services. My hon. Friend the Under-Secretary of State for Public Health recently launched our latest advertising campaign against smoking. I am especially grateful to Trudi Endersby, who was diagnosed with lung cancer at the age of 38, and had the courage to appear in that television campaign describing how she went with her daughter to choose a plot for her own grave, thus bringing home to people the dangers of smoking.
	I think that all hon. Members will agree that we need to do far more to alert young people, many of whom are gambling with their future health and happiness as they turn to smoking, binge drinking and risky sexual behaviour. I particularly want to commend the work of Professor Iain Hutchison, one of our leading oral and maxillofacial surgeons and a professor of surgery at St.   Bart's hospital, who founded the Saving Faces charity. He has described to me how he and his colleagues have gone into schools to show teenagers in horrifying and graphic detail what it means to have oral cancer, and to explain the impact of smoking and binge drinking on the risk of contracting oral cancer. I agree with the hon. Member for Billericay that we need more of those public awareness campaigns, and we will ensure that there are more of them in future.
	So we need to do more on prevention. However, we cannot prevent every cancer, at least not with our present state of scientific and medical knowledge. It is therefore essential that we keep doing even more to detect cancer early. In 1996, 1 million women were screened for breast cancer. This year, nearly 1.5 women will be screened, and we can be proud of the fact that the breast cancer screening programme that we operate is widely regarded as one of the best in the world. The number of breast cancers detected through our screening programme has increased from some 8,500 a year to 12,000 a year, which will lead to further improvement in survival rates. The latest estimate is that that one screening programme alone is already saving the lives of about 1,400 women a year.

Sadiq Khan: My right hon. Friend has talked about the importance of detection and early diagnosis. Will she commend the network of pilot clinics that has been set up at St. George's hospital to examine the links between family history and the diagnosis of cancer? The project is already a success in south London. Does she think that it could be extended further around the country?

Patricia Hewitt: I commend the excellent work that is being done at St. George's. The targeted identification and screening of individuals whose family history suggests that they are at greater risk than the rest of the population will play an increasingly important part in the early diagnostic work that we do.

James Gray: Is the Secretary of State saying, therefore, that, rather than screening women for breast cancer automatically when they reach 50, she might move towards automatic state-funded screening at an earlier age—possibly 40 or 45? Is that a possibility for the future?

Patricia Hewitt: At this point, the evidence does not really support the case for what would be a substantial investment in universal screening for all women in their 40s. However, we are of course looking at the research on that—indeed, we are funding much of it—and we expect further results from it later this year.

Howard Stoate: Every time in the past few years that I have referred someone with a suspected cancer, they have been seen and dealt with within two weeks. Does my right hon. Friend agree that it is a fantastic tribute to the enormous amount of work being done by doctors, nurses and others in the health service to achieve such tremendous results, reassuring patients who do not have cancer and dealing rapidly with those who do? That work greatly reduces the burden of anxiety felt by patients and their families.

Patricia Hewitt: rose—

Mr. Deputy Speaker: Order. Before the right hon. Lady replies, may I say that ever longer and more frequent interventions are having their own impact on the time available for debate? I am sure that everyone will be conscious that the Chair is trying to fit in a maiden speech today as well.

Patricia Hewitt: My hon. Friend the Member for Dartford (Dr. Stoate), who speaks with enormous authority on these matters, has saved me some time by making that point. In 1997, only two thirds of patients who were referred by their GP were seen by a cancer specialist within a fortnight. So, thousands of people every year were being told by their GP that they might have cancer, but were being forced to wait in agonising uncertainty for weeks on end before they could see a specialist. The fact that, today, 99 per cent. of patients see a cancer specialist within two weeks or less is hugely important.
	I know that the Conservative party does not like targets, and the hon. Member for Billericay has made that point again. The right hon. Member for Witney (Mr. Cameron) told the Health Service Journal that he wants to scrap national targets. The hon. Gentleman appeared to be arguing this afternoon that those targets, by concentrating on the early part of the patient journey, are distorting clinical priorities. I have to say that I do not understand how it can be a distortion of clinical priorities to ensure that a patient whose GP fears that they might have cancer is seen by a cancer specialist within two weeks. The people involved cannot begin to worry about the late stages of the patient pathway for somebody with cancer if they have not taken the trouble to diagnose the cancer rapidly in the first place. I believe—

David Tredinnick: Will the Secretary of State give way?

Patricia Hewitt: No, I shall make progress. I believe that we were absolutely right to set that target. I believe it has relieved anxiety for thousands of patients with suspected cancer. In achieving that early diagnosis, it has contributed to saving lives.
	Of course, we also have to treat people fast. That is why we set a further target—perhaps another that the Conservative party would abolish if it had the chance—that no patient should wait longer than a month from diagnosis to treatment, or more than two months from urgent referral by a GP to the start of their treatment. That is particularly important because, as the hon. Member for Billericay said, people in England—indeed, people across the UK—are more likely than those in other countries to be in an advanced stage of their cancer by the time they are treated, so getting patients not only diagnosed early, but through to their treatment as quickly as possible, is critical if we are to save people's lives and improve those survival rates.

John Baron: I take on board what the Secretary of State is saying, but she seems to forget that those targets relate to first treatment. Radiotherapy, for example, is first treatment in no more than 15 to 20 per cent. of cases. The risk is that these targets ignore the fact that the cancer journey can be long. Pulling resources into the front end means that radiotherapy waiting times look set to continue to lengthen at this rate.

Patricia Hewitt: We have never claimed that the patient pathway ends with the first treatment, but we have said that we must start by setting as a priority not only early diagnosis, but getting the patient through to that first treatment. The hon. Gentleman is quite right that at this stage we do not currently measure the waiting time for radiotherapy as a second treatment—in other words, after the initial surgery. We might need to do that next, which is one issue we will consider, but at this point we are seeking to ensure that we meet the one-month and the two-month targets. I believe we are absolutely right to do so.
	No one in the House should underestimate the challenge posed by meeting those targets to get patients very rapidly indeed to their first treatment for this very simple reason: the NHS has never before proactively had to manage patients—each individual patient—throughout their pathway of care.

David Tredinnick: Will the Secretary of State give way?

Patricia Hewitt: No, I want to make this point. Then I will give way to the hon. Gentleman, who has been very persistent.
	We have never, under Governments of either party, measured the delays in diagnostic tests, the time between additional out-patient appointments, the referrals between one specialist and another, or the referrals, often for patients with complex cancers, between one hospital and another—between the secondary and the tertiary centres, for instance. All those can add to delays, uncertainties, anxiety or even mistakes. We are changing all that, and it is a pity that the hon. Member for Billericay does not recognise the scale of our ambition, or indeed our achievement.

David Tredinnick: I hope that the Secretary of State will also address the various support services in the complementary sector, which are not commonly mentioned by Ministers, such as traditional Chinese medicine and acupuncture, particularly as the Government have been pressing for a statutory register, which should be coming on-stream soon. I would be grateful for an explanation of that. What is she doing to examine the contribution of advisory services on diet and lifestyle, because, as I mentioned earlier, according to reports from America 80 per cent. of cancers are caused by lifestyle issues?

Patricia Hewitt: I was not going to mention those points, as there is so much to cover, and I am sure that the hon. Gentleman will contribute to the debate on those matters later.
	We are making remarkably good progress towards achieving the targets that we have set for prompt first treatment. Between July and September last year, nearly 95 per cent. of patients had commenced their first treatment within 31 days of being diagnosed, and more than 80 per cent. of patients were treated within 62 days of being referred urgently by their GP. There is still much more to do on that, but we have made remarkable progress already.
	I want to deal with the issue of cancer drugs, and particularly herceptin, which has rightly been a focus of much of the debate already. I pay tribute to the superb campaigning of Barbara Clarke—who is taking an interest in this debate—and other women. When we heard the results of the initial clinical trials last year, which suggest that herceptin can make a very significant difference to perhaps one in four women who are HER2 positive and have been diagnosed with breast cancer, we immediately considered the implications for the national health service. In particular, I took steps, with the support of Professor Richards, to ensure that HER2 testing will be available across England to all women diagnosed with early-stage breast cancer, so that they and their clinicians will know whether they might be able to benefit from the drug.
	The hon. Member for Billericay is right, however, to point to the difficulties that arise with drugs, not only herceptin, that are neither licensed nor evaluated by NICE for use. We have made it clear as general guidance for many years that no primary care trust should refuse any treatment on the blanket grounds that it has neither been licensed nor evaluated, because it is entirely possible for a clinician to prescribe treatment that is neither licensed nor evaluated—or that might have been licensed but not evaluated—and for a primary care trust to fund that treatment. In the light of the risk that herceptin might be ruled out because it was not licensed, not evaluated, or solely on grounds of funding, I added to the guidance already issued by making it clear that primary care trusts should not refuse herceptin purely on grounds of cost.

Ian Liddell-Grainger: The Secretary of State is right. Herceptin is licensed for late-stage breast cancer, however, and has been for some time. Barbara Clarke's campaign was to get it licensed for early-stage breast cancer. Does the Secretary of State agree that if that could be rolled out across the whole United Kingdom—it is already in Scotland and Wales—we would resolve the problems that my hon. Friend the Member for Billericay (Mr. Baron) was talking about?

Patricia Hewitt: I was about to explain why we cannot do what the hon. Gentleman suggests at this point. In fact, I am not sure what he was suggesting; I think he was quite confused about it. He asked for national standards. That was our aim in setting up NICE: we wanted to end the lottery of postcode prescribing. NICE, however, cannot evaluate a drug before a licence has been applied for. It simply does not have the information that will enable it to evaluate the drug if the manufacturers who have that information from the clinical trials have not yet submitted it to the licensing authority.
	Although, as the hon. Gentleman says, herceptin has been licensed for some time to treat late-stage breast cancer, it has not been licensed for early-stage treatment. When a fast-track licence was requested from the licensing authorities, the clinicians involved in the decision took the view that it would be wrong to put herceptin through a fast-track process for early-stage treatment because of serious concern about side-effects relating to heart disease. That is not a worry if a woman is in the late stages of breast cancer, but it can be of significant concern if the woman is in the early stages.

Ian Liddell-Grainger: rose—

Patricia Hewitt: I will not give way to the hon. Gentleman again at this stage. I have been pretty generous.

Michael Wills: I am grateful to my right hon. Friend for giving way, especially as my intervention relates to a constituent. I am sure that she was well aware of the case even before the premature intervention of my neighbour, the hon. Member for North Wiltshire (Mr. Gray). I shall leave the House to judge whether it was inappropriate.
	As my right hon. Friend knows, I have written to her several times on behalf of my constituent. I think that everyone who considers that case, and indeed the whole issue, realises just how difficult and delicate such matters are at this stage in the development of drugs. I welcome my right hon. Friend's rapid and sensitive intervention last year in an attempt to deal effectively with a very difficult issue. May I ask her, however—

Mr. Deputy Speaker: Order. The hon. Gentleman has gone on for far too long. I have already appealed for brevity, and indeed for fewer interventions, if we are to have any debate at all involving Back Benchers.

Patricia Hewitt: I will be guided by you, Mr. Deputy Speaker. However, my hon. Friend has raised an extremely important and difficult case, to which I referred in a written statement earlier today. As an appeal is pending, I do not think it would be appropriate for me to comment on the individual case, which is of course particularly difficult and painful for the individual concerned and her family. I think we all recognise that.
	As I have said, NICE cannot begin to evaluate a drug or a new application before a licence has been applied for. What we did—I pay tribute to the Minister of State, Department of Health, my right hon. Friend the Member for Liverpool, Wavertree (Jane Kennedy), who did much of the work—was enable the NICE evaluation to be speeded up, for herceptin in particular but also for a number of other drugs, especially cancer drugs. We did that by ensuring that, rather than having to wait until the licence is granted, in cases such as this NICE can begin its evaluation as soon as the licence is applied for. I can confirm that it has begun its evaluation of herceptin, following Roche's recent and welcome application for a licence.
	The first five drugs to be subjected to the new faster process—the single technology appraisal by NICE—are cancer drugs. We expect the evaluation of herceptin to be completed within a few weeks of the granting of the licence, but until the evaluation has been completed and the licence granted, it would be wholly wrong for me as Secretary of State to overrule or prejudge the decisions of either the licensing authority or NICE. The hon. Member for South Cambridgeshire appeared to be saying that I should not do so. It is a pity that he has not supported me.

Andrew Lansley: The question surely is this. The Secretary of State chose to intervene last October. It surely cannot be her proposition that primary care trusts are obliged not to refuse treatment on grounds of cost alone. She intervened in respect of herceptin. When NICE conducts an evaluation, it automatically feeds through into the resources that are made available to PCTs. There is no NICE evaluation. Therefore, no resources to support herceptin are allocated to PCTs in their overall allocation. The Secretary of State gave the impression that PCTs would be funded to provide herceptin if they thought that it was clinically appropriate, but she did nothing of the sort.

Patricia Hewitt: The hon. Gentleman is wrong. What I said at the time I made my statement was that I recognised full well the difficult financial position that some primary care trusts found themselves in, and that they would have to make difficult decisions on priorities in order to ensure that herceptin was not denied purely on grounds of cost, but I think that he labours under a misapprehension. As we have set out clearly, when NICE evaluates a drug and makes a positive recommendation, the NHS then has three months to ensure that its recommendation is followed. However, the NHS is expected to do that within the funding that it has already been given. There is not a separate pot of money sitting in the Department of Health waiting to be allocated as each NICE evaluation is made.
	We have given primary care trusts, the local NHS, more money than ever before and devolved to them some 85 per cent. of the total health budget—a devolution of resources that I would have thought the hon. Gentleman supported—it is simply not possible to say, for each new drug that comes along, when it is positively evaluated by NICE, "Here is more money for that drug." It would not be a sensible way to allocate resources.
	The resources are allocated in a single pot. They are not ring-fenced for a particular drug. They are not even ring-fenced for drugs as a whole. It is up to the local NHS, the PCT, to decide its priorities and to get the best value for money to ensure that patients receive the best possible health care and that funding is released for new drugs and therapies as they become available.

Owen Paterson: Can the Secretary of State explain in simple terms to a 10-year-old constituent of mine why their parents, who have paid their taxes, are having to spend a day in Shrewsbury starting to raise £47,000, when their neighbours two miles away in Wales are getting the drug? We do not have national health, or so-called national care, but we do have national comprehensive taxation.

Patricia Hewitt: The NHS in Wales, for which, of course, I am not responsible—that is a devolved matter—looks to NICE, as indeed much of the rest of the world does, for the evaluation. I make decisions about the NHS in England. I believe, and I thought at least at one point in the speech by the hon. Member for Billericay that he agreed, that it would be wrong for a politician to override, pre-empt or prejudge the decisions that should rightly be made by the independent licensing authority and by NICE.

John Baron: I believe that the Secretary of State is somewhat confused herself. Does not she realise that, by intervening as she did, that is precisely what she did? She overruled NICE—she pre-empted NICE, I should say; I apologise. She caused confusion. She has not given extra budgetary finance to those PCTs that want perhaps to bring it in. That has caused more of a postcode lottery than existed previously.

Patricia Hewitt: I am sorry but the hon. Gentleman is wrong. I was very careful in everything I said on the subject last year not to pre-empt NICE. If he cares to ask Professor Mike Rawlins, the chair of NICE, he will find that Professor Rawlins and I are in complete agreement on that point.
	As I said earlier, we have said for some years that PCTs should not deny or withhold treatment on a blanket basis—simply on the grounds that a drug is neither licensed nor evaluated. In addition, I have specified that they should not withhold funding for herceptin on a blanket basis purely on the ground of cost; rather, they must consider each individual case. If a PCT decides not to fund such treatment, that decision can of course be reconsidered on appeal by the clinical exceptions committee. The more that such decisions are taken by clinicians, the better.
	I shall end my remarks—I am conscious that a number of colleagues wish to speak—by referring to the surveys carried out by the National Audit Office between 2000 and 2004, which have confirmed the significant improvements in cancer treatment to which I have already referred. They show that fewer patients reported a deterioration in their condition while waiting for treatment. Of course, fewer patients now wait weeks or even months for treatment—a wait that was, I am afraid, a feature of cancer treatment in the past. Perhaps most crucially of all, nearly nine out of 10 cancer patients reported that they were treated with dignity and respect at all times.
	We are just halfway through implementing the national cancer plan. As I believe Members in all parts of the House will accept, we have already made great progress, but as I would be the first to acknowledge, there is a great deal more that we have to do. But given our continuing investment in cancer services and the record sums going into the national health service; given our confidence that by the end of 2008—after two more years of record increases—we will have achieved the European average in health care funding; given the extra specialists, the new drugs and the continuing drive for an improved patient experience and proper support throughout the cancer journey; given the provision of better advice and more choice and control for patients; and given the provision of more care in or near the home, as reinforced by our recent White Paper, I believe that we are well on the way to making Britain's cancer services among the best in the world.
	All the progress that we have already made and will make as we continue on this course in the years to come would be jeopardised by the new fiscal rule announced by the Leader of the Opposition, the right hon. Member for Witney, as confirmed in his most recent statement. That "proceeds of growth" rule would inevitably mean cuts in the NHS budget—thereby reversing the progress that we have made—longer waiting lists, fewer specialists and poorer services for cancer patients.
	Much has been done but there is more to do and we have an absolute determination to do it. I commend the amendment to the House.

Steve Webb: I know that the House is keen that Back Benchers have the chance to speak before the winding-up speeches begin, and although this is a very important topic that, to judge by the contributions that we have heard so far, deserves a lot more time than has been allocated to it this afternoon, I will curtail my remarks, not least in the hope that my hon. Friend the Member for Dunfermline and West Fife (Willie Rennie) can catch your eye, Mr. Deputy Speaker, and make his maiden speech.
	I want to focus on the crucial issue of cancer drugs and access to them, but first I want to place on the record my support for the 10-year cancer plan, which, as has rightly been said, has made an important contribution. However, I hope that the Government will say whether and when they plan to renew and refresh that plan, because we do not want it more or less to expire, and then to be presented with a new 10-year plan. Cancer treatment provision and cancer prevention is a long-term process, so we need a long lead time into the next stage of the cancer plan. I therefore hope that the Minister can tell us this evening when we will get the shape of the next plan, rather than waiting until the   current one ends. We need a longer-term horizon than that.
	I turn briefly to the important issue of the "prescription for change" campaign by Breast Cancer Care, which has highlighted an anomaly. People diagnosed with breast cancer or other cancers would once have died shortly thereafter; now, they can expect to live for much longer, but as a result they suffer prescription charges, whereas people with other conditions, such as diabetes, do not. Prescription charges are causing problems for cancer patients. For example, the Minister may not be aware that a Breast Cancer Care survey found that 15 per cent. of cancer patients had not taken up the prescriptions given to them by doctors because of their cumulative cost. There is an arbitrariness in the prescription system, for example between diabetes and cancer. That was not so important in the late 1960s, when the rules were drawn up, but it is a problem now. The present system can be defended only on the grounds that it is the one that we have got and that changing it would open up a can of worms. However, that is not a good enough reason not to look at it.
	I shall focus on the question of access to expensive new drugs. We will talk about herceptin today, but there will always be another new drug just around the corner. Herceptin is going through the NICE licensing process for use in early-stage breast cancer, and we hope that it will soon be approved, but our answer to the question of access must work every time, for each expensive new treatment that comes along.
	My comments are informed by a meeting that I had yesterday with oncologists from Addenbrooke's hospital. They wrote to me and other hon. Members last July about the inaccessibility of herceptin, and said:
	"As a group, we are conservative"—
	with a small "c" in that context, I am pleased to say—
	"in our response to new treatments. We usually strongly resist pressure to switch our patients to new and expensive drugs for marginal benefits. But the recent trial data demand immediate action since these are certainly the most stunning results that any of us has seen during our entire professional careers."
	It is interesting to note that, since the oncologists wrote that letter, their patients can now access the unlicensed drug herceptin for early-stage breast cancer. It was their clinical judgment that that should happen, but other PCTs have concluded that that would not be the right thing to do for clinical reasons. How can such matters be dealt with systematically? That is the important question, as our constituents sense that the present requirements are unacceptable.
	The hon. Member for Billericay (Mr. Baron) said the same, but did not propose a solution. I agree that it cannot be right that a woman suffering from breast cancer should have to go to court to get herceptin. The hon. Member for North Shropshire (Mr. Paterson) has intervened more than once to say that it cannot be right either that a woman who happens to live in Shrewsbury cannot get herceptin, while one who lives in Staffordshire or somewhere else nearby can. Neither circumstance can be right, but we have not heard how such inconsistencies are dealt with in connection with drugs that are neither licensed nor approved by NICE. I shall make my own suggestion about that in a moment.
	Some key questions on herceptin remain unanswered. First, what have the Government done to try and get it more cheaply? On average, the NHS pays more for drugs than most other health services—a fact confirmed to me in a written answer from the Department. Have we used the buying power of the NHS to beat down the providers and get a better price? That approach must be both sensible and desirable, although I understand that the producers need their research budgets and an incentive to carry out research. That means that there is a limit on how far prices can be brought down but, if other health services can do it, why cannot ours?
	Secondly, the hon. Member for Billericay said that other European countries adopt new drugs much earlier than we do. Why is that? Many other European countries have better survival rates than the UK, and that is very closely linked to our failure to take up new drugs earlier. Why do the Government think that our health service is, on average, slower to adopt new treatments? What assessment has been made of that?
	On unlicensed drugs, I stress that I am speaking for myself, and that I do not ascribe my views to the consultants to whom I spoke yesterday. However, they pointed out that unlicensed drugs are used all over the place and said, "Paediatricians do it all the time." Licensing is for the benefit of patients, and is about patient safety. If patients are told that the trials and tests of a drug remain incomplete and that there is a risk attached to its use, they might still conclude that they are not willing to accept the risk of not using the drug. In those circumstances, why should the patients be told that they cannot take an unlicensed drug, simply because it is unlicensed? That cannot be right.
	The fact that a drug is unlicensed should not be a barrier, but we do not have a system for the systematic appraisal of unlicensed drugs by clinicians who want to give them to their patients. Such a system would mean that the use of new drugs would not vary by postcode, or require people who want them to go to court. That is the sort of system that we need, and I shall make a suggestion to that effect in a moment.
	I share the concern that has been expressed about the Secretary of State's intervention last October. She made a statement on 5 October that reiterated the undertaking that herceptin would be fast-tracked when it was brought forward for licensing. Obviously, we welcomed that. However, that statement, subsequent clarification by the Department of Health on the same day and the Secretary of State's speech to Breakthrough Breast Cancer have, according to a PCT guidance note on access to herceptin:
	"raised considerable expectation that NHS patients will, from now, be prescribed"
	early-stage herceptin
	"even though the announcement relates only to provision of testing".
	Whether the Secretary of State likes it or not, she clearly raised expectations. She must accept that, because there is plenty of evidence that people heard that on the news and concluded that she was telling trusts not to refuse to prescribe it. I know that she said that they were not to refuse to prescribe it on cost grounds, but does she seriously think that if herceptin cost £1 a dose any PCT in Britain would refuse its use to clinicians who asked for it? That is patently not so. If clinicians had judged that herceptin, although unlicensed, was in the best interests of their patients—and the patients knew the risks and were willing to take them—no PCT would say no in those circumstances.

Andrew Lansley: Strictly speaking, some clinicians would say no in those circumstances. For example, in the Thames Valley strategic health authority, advice has been derived from a joint professional group that clinicians should say no to herceptin, on the grounds of the risk associated with an increase in coronary heart disease.

Steve Webb: I was talking about primary care trusts saying no when clinicians said yes. If clinicians have a patient whom they believe would be ideally suited to the treatment, they have explained the risks and the patient is prepared to take those risks because the alternative would be worse, the money would be found for herceptin if it were not so expensive. That is cost rationing, and it is no good pretending that this is not about cost. The Secretary of State told trusts not to say no on grounds of cost alone, but that clearly raised expectations that cannot be met. That is the danger of the Secretary of State intervening as she did.
	We have all heard about the North Stoke case. How can it be right that one person gets the treatment because they have got on the news, the Secretary of State has thrown her weight around and, the next day, the PCT changes its mind, but another woman, who does not get on the news, does not get the treatment? That is not a rational way to allocate those treatments.
	My local PCT in south Gloucestershire does not fund herceptin, on clinical grounds, because there is an academic study that says that four years down the track the chance of surviving is enhanced by only 5 per cent. However, that study was based on a broad category of women. I put that point to the consultants at Addenbrooke's yesterday and they said that out of the big sample one could pick sub-groups who have a far better chance of survival. The drug is ideally suited to some women, for whom the statistics would be much better. My local PCT has picked one study and interpreted it in a particular way and will not prescribe herceptin, but if my constituent who needs the treatment were living in Cambridge, she would get it. That cannot be acceptable.
	It is all very well identifying the problem, but what should we do? We need a mechanism for allocating unlicensed and unapproved drugs. We cannot continue with the random and arbitrary approach that we take now. That has to be done nationally. The hon. Member for North Swindon (Mr. Wills) was right to identify a conflict between a belief in localism, local discretion and responsiveness to local circumstances, and consistency and avoiding postcode lotteries. On many things, my colleagues and I are on the side of the localists. We want local discretion over patterns of service and provision. However, I do not think that any of our constituents believe that it is right that whether a patient gets a drug should depend on where they live. That does not come into the category of decisions that our constituents believe should be made case by case, on a local basis. Therefore, we need a central evaluation process for such treatment, pre-NICE. The alternative is arbitrariness—randomness, going to court, postcode lottery—on treatments that could save lives. It must be one or the other. We cannot have both.
	That arbitrariness so offends our constituents' sense of natural justice that we cannot go on. Yes, the problems with herceptin will be sorted in six months—we hope—but the next set of problems will not be. Clinicians tell me that avastin will be the next cancer wonder drug and that it will make herceptin look cheap, so we have to tackle the issue. Such drugs will first be unlicensed and then licensed but not approved. The faster the NICE approval process, the shorter the pre-NICE process I suggested, but it will have to exist, otherwise there will be only the arbitrariness and unfairness that we all feel offends against our sense of natural justice.
	It is no good pretending that there will not always be rationing, but it must be systematic and consistent—

Julia Goldsworthy: And rational.

Steve Webb: Indeed. If there is a national process for a limited period for a limited number of treatments, it will be better than the present arbitrariness. I hope that the Government will give the proposal serious thought.

Several hon. Members: rose—

Mr. Deputy Speaker: Order. Before I call the next speaker, I point out that the 10-minute limit on Back-Bench speeches applies from now on, but as many Members are seeking to catch my eye it would obviously be more than helpful to all of us if people could take a little less than their allocated time.

Andrew Smith: I am pleased that the Opposition have chosen to debate the future of cancer services today, because this morning, in my constituency, the groundbreaking ceremony was held for the inauguration of the new Oxford cancer centre at the Churchill hospital site. It would be difficult to find a better pointer to the progress we are making in cancer care and treatment and to further improvement in the future.
	The new £109 million centre, due to open in 2008, brings together cancer services that are currently scattered across three sites—the Radcliffe infirmary, the John Radcliffe hospital and outdated buildings on the Churchill site. It will combine all the clinical teams—surgeons, oncologists and support staff—in one place, providing prompt diagnosis and even more effective treatment, thereby contributing to fulfilment of the national cancer plan and improving outcomes by enabling more patients to come to Oxford for specialist cancer treatments that can most effectively be provided only in more specialist centres.
	Patients will benefit from still closer collaboration with Oxford university, ensuring that their care is informed by the most advanced research into new cancer treatments. The new centre will include a women's health service, with a dedicated ward where patients with gynaecological or breast cancers will be cared for. Like most of the other patients, they will be able to have all diagnostic tests and treatment, whether surgery, chemotherapy or radiotherapy, on the same site.
	The building, which will include a geothermal heating system pumping up heat from 120 m below ground level, was designed with advice from cancer patients themselves, who particularly wanted it to be as light as possible and to include many natural materials. Involving cancer patients in the design of such an important new facility is an extremely positive development.
	Such a level of investment in cancer services just would not be happening if the Opposition had had their way when they voted against increased funding of the health service and, as my right hon. Friend the Secretary of State said, it would be at risk in the future if they had the chance to bring in their proceeds of growth rule, which would hold public spending to a lower rate of growth than the economy as a whole, regardless of the need for investment in public services. What is more, in Oxford, as elsewhere, cancer patients and services are benefiting from the fulfilment of the ambitious targets that the Opposition want to remove.
	In January, every patient referred to the John Radcliffe under the two-week maximum wait rule was seen within the target time, and the number of cancer patients seen within two weeks is three times more than it was as recently as 2000—we cannot go back as far as 1997. That achievement is a result of the extra resources for staff, the better organisation of services and the streamlining and improving of patient access to cancer services across the trust.
	In the past three years in Oxfordshire, the NHS has invested an extra £4 million in cancer services. New consultant oncologist, surgical and nurses specialist posts are examples of the investment in the clinical work force who are providing cancer care. The introduction of one-stop clinics, faster access to diagnostics and other improvements have particularly benefited gynaecology and urology services.
	Most importantly, though, staff at all levels have gone the extra mile to ensure patients get a better, faster service—for example, by working extra hours to clear any backlog of patients who are awaiting radiotherapy. Since November, they have succeeded in maintaining no waiting time at all for new patients referred for radiotherapy. No praise is high enough for the staff who are achieving that performance through their dedication.
	Getting to the current performance has been a challenge, and sustaining it will be a challenge, too. The trust will need to recruit more medical, nursing and other support staff to sustain the highest delivery performance, particularly for some clinical services, such as paediatric oncology and radiotherapy.
	In high cost areas such as Oxford, there is a certain vulnerability to staff shortages in specialisms that are experiencing a national shortage, such as therapy radiologists and physicists. That makes the national drive to train and recruit more people in those specialisms especially crucial. It also means that the battle to provide more homes in central Oxfordshire is not just a housing policy, but a health service priority as well.
	Another challenge is to get right the tariff for payment by results, which is particularly crucial for specialist centres as they move towards foundation status. It would be helpful if the Minister said more about the prospects for the announcement of the tariff following its recent withdrawal after it had been sent out. Clearly, it would be better if hospitals avoided such uncertainty just weeks away from the new financial year.
	On the funding of new cancer drugs, hospitals and PCTs will clearly face continuing difficult pressures. The NICE procedures are the right way to resolve fairly and objectively which drugs are cost-effective and should therefore be available, but the difficult question remains of where cost-effective might not necessarily mean affordable.
	A judgment that is fair to all must take account of what other treatments and which other patients are displaced by the resource consequences of such difficult decisions. That is why the Opposition Front-Bench team's proposition of handing everything over to NICE simply will not work. Surely, commissioners must be ultimately responsible for those decisions, but we all know that the minute that one PCT comes to a different conclusion from another, there will be cries of "postcode lottery".
	Unlike the Opposition Front-Bench team, I do not think that there is an easy answer. Clearly, a consensus is needed on how to deal with those difficult choices. Although, as ever, I followed with interest the comments of the hon. Member for Northavon (Steve Webb), I am not sure whether he has necessarily got the answer. Further close attention and public debate must be given to this vital issue.
	I could not speak in a health service debate without raising the continuing problem of the current year's financial deficit and its impact in Oxfordshire. I do not for a moment think that the remaining deficit can be eliminated in the weeks that remain of this financial year, and as Ministers come to accept that, the question will shift to one of on whose books the deficit most properly belongs—an issue of more than accountancy significance, because of its impact on finances next year. As things stand at the moment, all the deficit would be left with the Oxford Radcliffe hospitals trust, but that would not be right, given that the financial problems in Oxfordshire are not all of the Radcliffe's making.
	A fairer and more rational allocation of the deficit needs to be found. That would be better for patient care, as well as for the finances at the Oxford Radcliffe hospitals trust, which has made enormous progress in recent years in turning round its financial position and costs, as well as in delivering the first-rate cancer care about which I have been speaking, and I am confident that, with the investment that Labour is making, that will go from strength to strength in the future.

James Gray: I am glad to follow the right hon. Member for Oxford, East (Mr. Smith) and I agreed with much of what he had to say, particularly when he was talking about the great advances in cancer care in England in the past 10 or 20 years. However, quite frankly, it would have been rather surprising if those advances had not taken place. It would have been a scandal if we had been saying in today's debate that cancer services were precisely where they were in 1997, 1987, or 1967.
	Although things have got a great deal better, I disagreed with the right hon. Gentleman when he became party political and seemed to indicate that that change was because of the Labour party. That was rather reminiscent of comments made by the right hon. Member for Airdrie and Shotts (John Reid), who, at the Labour party conference in 2004, said:
	"in the first 6 years of this government, the death rate from cancer is down by over 10 per cent . . . Isn't that just the sort of thing Labour came into government to do? . . . Thousands of real people walking the street who would not have survived under the last Tory Government."
	That sort of remark—and one or two of the comments made by the right hon. Member for Oxford, East—is quite wrong. The achievements have been made thanks to scientists, clinicians and doctors.
	I speak from personal experience. About this time last year, during the general election campaign, my wife was diagnosed with breast cancer. We were somewhat discombobulated by the surgeon, who told us that the operation would be on 5 May. We had to tell him that we would be otherwise engaged then and would have to delay the operation by a week or so. I am glad to say that the subsequent care that my wife received was excellent in every possible way and that she has been given a clean bill of health. I pay tribute to the care workers at the Royal United hospital in Bath, and at Chippenham, Swindon and elsewhere, who achieved that. However, I have to say—I hope that this will not disappoint the Minister—that I do not thank the Labour party for achieving my wife's good health; I pay tribute to the scientists and health workers. It is probably wrong to reduce the matter to a party political issue.
	That is why I welcome the positive tone of the motion. We are saying how well things have gone: a lot of money has been spent and a great deal has been achieved. However, the truth of the matter is that there is an enormous amount more to achieve. We do not know the cause of breast cancer. For example, why does it almost not exist in the far east? Is that something to do with health and diet? It probably is. Why is there a high incidence of breast cancer among left-handed women? We do not know, but it would be useful to find out. We need to spend more money on research. My wife happens to be left-handed, which is why I know that statistic.
	On care, of course it is good that we have a target of people being seen by a specialist 14 days after they are first diagnosed by a GP, but the average waiting time in 1997 was only 11 days, so the much-vaunted 14-day target is not particularly useful. What it does result in, as I discovered when I accompanied my wife on that fateful day, is a waiting room packed full of people. I said to the surgeon, "Why are the waiting times so long? Why do we have to sit here from 8.30 am to 2 pm before being seen by you?" He said, "That is to achieve the two-week target. We cannot lay down when people are diagnosed. They have to be seen within two weeks and the clinic has to be jammed full to achieve that target. If we were allowed a certain flexibility in terms of days, it might be easier to organise timetables better." The targets may sometimes have the wrong results and are not all that they are cracked up to be.
	We have to see some improvements in waiting times for treatments. My wife heard today that she will receive her radiotherapy within four weeks, but many women are still waiting for six weeks or longer. Surgery and chemotherapy tend to be done in good time, but there is a long delay on radiotherapy, even though it is an important part of the treatment.
	There has been a terrific muddle with the prescribing of drugs. We have heard a great deal about herceptin, but the same situation will apply over the years to come to a variety of other groundbreaking new cancer drugs. We need to find a way in which NICE can license and approve them speedily. We cannot have another situation like the one last October when the Secretary of State encouraged women at the Breakthrough Breast Cancer event—I was there—to think that herceptin would become available, only for them to discover that it will become available only if there is plenty of money to pay for it, which there is not.
	The experience of Anne Marie Rogers, in my neighbouring constituency of North Swindon, is a vehement comment on the awful effects on women who are discovering that they may face a shortened life as a result not of anything to do with clinicians, but of a shortage of money and of Government decisions. An awful lot needs to be done in that respect and in relation to radiotherapy. In particular, an awful lot needs to be done on research.
	I pay tribute to the very high standard of care that my family have benefited from in the last 12 months, and I think that we see that across the book. I do not accept that that is anything whatever to do with the Labour Government. It seems to me that science is developing quickly and that wonderful support and services are provided by doctors, nurses and researchers in our hospitals, and I pay tribute to them. I very much hope that, 10 years from now, we will have seen the statistics improve even further, and that when a Conservative Secretary of State is standing at that Dispatch Box he does not fall into the easy trap of claiming that as a Conservative victory.

Ian Gibson: This has been a very British debate. We should really be celebrating the excellent and magnificent work that has been carried out in cancer services since 1990, but particularly since 1997. I speak as someone who has chaired the all-party cancer group since 1998 and who worked in the field for many years, with patients and doing research.
	You may remember, Mr. Deputy Speaker, that you and I once put some bricks into a wall around an accelerator at Ipswich hospital, some time after a Labour Government came to power. There are many such stories to be told.
	Why did I set up the all-party group? People were in the habit of setting up an all-party group for every part of the body that got cancer. Somebody once asked me if they could have an all-party group on right-knee cancer, and at that point I said, "No way. You can work within the bigger all-party cancer group. There is no reason why things cannot be considered under that umbrella."
	I remember, too, a Select Committee report on cancer in the 1990s, after the Labour Government came to power, which came up with the idea of joining two major cancer charities, the Imperial Cancer Research Fund—hon. Members will remember that name—and the Cancer Research Campaign. At a meeting we were told by a man who became a Nobel prize-winner in this country, a scientist backed by British money and British technicians and workers in various universities and institutes in this country, that those two charities could never merge. One reason was that they were like Omo and Daz. That did not fool me because those two products are made of the same chemical substance and can be mixed.
	The scientist also said that the charities would not get as much money if they came together. They fund most of the research in this country, and that came about through support not only from the Select Committee but from the Government. The charities get twice as much money now as the total that they got acting singly, which means that more research is being done, more projects are being funded and more young people are being given the opportunity to discover things. Although it is true that science has moved on and discovered much in cancer, it has been supported to a huge extent by the Labour Government.
	I sometimes feel like going back and doing research because I have had many grants turned down, and I would have a much better chance now. I see that the Minister agrees that I should go back, before a few more votes are taken. I do not think that cancer research has ever been in a better state. In 1992, to give the Opposition credit, they implemented the Calman-Hine report so that the process started, but the acceleration really happened in 1997 and 1998.
	I think too that there is a new understanding, and that is the essential feature. We used to teach students that genetics had nothing to do with cancer; it was all environment. Genetics has everything to do with cancer. We understand the causes of a genetic change that brings about a rogue cell that develops into a cancer. [Interruption.] I see that the Opposition are coming in to listen.
	Understanding those genetic changes allows people to target drug development. Herceptin is one such drug, glivec is another, and there will be many more. We are also going to understand the genetic basis of who will benefit from treatment with a drug and who will not. That has been pioneered in Dundee using a certain drug. Now, in this field, genetics is all, and making that discovery has given us Nobel prizes—prizes that, incidentally, were won working not on cancer cells but on yeast cells. That shows that basic blue-skies research can often turn up things that have a medical advantage, and we should remember that.
	We have had two British Nobel prize-winners at a time when we thought we were losing out. There are more to follow. I predict that, in the not-too-distant future, work being done at Dundee university will win a Nobel prize. Scotland deserves another one.
	There is a new subject called bioinformatics, which is all about fancy computers, that allows us to look at amazing pieces of information. There was a shortage of people when bioinformatics were first discovered. We are now making up for that shortage by training people in colleges and elsewhere. We are punching our weight in this area. We shall make many more discoveries and we are supporting young people who are trying to develop career structures. We are enticing them. We are trying to change science in medicine that is taught in schools. Why should pupils in schools not be taught about cancer, for example? That is a good example of the things that we have done, the things that we can do and, if we get down to it and get more support from Government, the things that will happen in future. We maintain our position very well throughout the world.
	I give credit to my right hon. Friend the Member for Oxford, East (Mr. Smith), who mentioned the work at Oxford. He did not mention—I was proud of this—a young 16-year-old who was leading a demonstration at Oxford that was supporting limited animal experiments. We are not saying that all work should be done with animals, and perhaps some of it should be done with computers and tissue cells, for example. The right to be able to do that is so important. Before a licence, there is a need for the toxic test. We do not stick drugs into patients and hope that they do not die. Certain tests have to be carried out in the hope that results will be obtained before the licence.
	The changes that are coming about in scientific discovery will make a real difference. Quite often in science and medicine, discoveries happen long before politicians, particularly those who are lawyers, can pick up on what they might mean in terms of new laws and regulations, for example. We have genetic modification and stem cells. Many of us knew about stem cells before the many debates in this place that led to us ensuring that we could continue with research. We are hopeful that that research might pay off.
	Much has been said about the cancer plan that came through for 10 years. We are halfway through that. Many new people have been appointed. Consultants are pouring out of oncology departments in our hospitals, and there are more to come. This is real encouragement. For the health service in general, such developments have stimulated mental health people and those who work in cardiology, heart disease and so on. How did these people do it? I will tell the House: politicians, scientists and medics worked together. There is huge team work. There are 20 cancer research charities and voluntary groups that meet once a week in this place to discuss various issues from a professional, knowledgeable position. That is what we have created since 1997, and that is important. Let us do away with competition and get people working together who have the best experiences.
	I heard a woman from the Christie in Manchester talking about best practice there. She was telling 19 other people how it was done. That is excellent, and that atmosphere should be encouraged. We have talked about NICE and quality of life. People with cancer, in their last few years or days, experience tremendous fatigue. We can do things about that. There is the stimulation of blood, for example, which will stop these people being tired. NICE should be asked to examine that.
	Of course, NICE will evolve. It will learn by some of the mistakes that have been made. That is what it has all been about. Thank goodness that NICE has been in place to give us some evidence-based knowledge of what we do and of what we do not know. That knowledge will increase.
	The vision that we have in the all-party group—please join it—is how we are going to take things on. We realise that cancer is a complete journey from the early diagnosis, through treatment and then on to care in hospices, including palliative care. The passport needs to be examined. There should be no piecemeal approach when it comes to putting in money. The patient should be considered throughout.
	I am excited about what is happening, but I think that there is more to do. What we have managed to do in providing better cancer services will stimulate us to do even better, as we learn more. That knowledge will come from science, medicine and practice. We have an enthusiastic work force who want to try to do things. In the light of experiments and clinical trials—more and more of that is going on with the necessary resources—we shall learn best practice.

Willie Rennie: I am grateful, Mr. Deputy Speaker, for the opportunity to give my maiden speech and to contribute to our debate on cancer services.
	It is a pleasure to follow the hon. Member for Norwich, North (Dr. Gibson), who has a distinguished record on cancer and in science, which is close to my heart. It is an interesting and bewildering experience to enter Parliament outside the usual intake, and I thank colleagues on both sides of the House who have helped and supported me in the past couple of weeks. When my predecessor, Rachel Squire, was elected in 1992, she brought to the House a background in social work and union representation. She brought, too, a passionate belief in the importance of equality of opportunity for women. Most importantly, she brought a warm personality and a strength of character that was appreciated on both sides of the House. Her death this year from a brain tumour was a tragedy for all who knew her. What struck me most was her dedication to her constituents, for whom she fought with tenacity. I hope to do just the same.
	Dunfermline is the historic capital of Scotland. Indeed, the body of Robert the Bruce, who gave the town its charter in 1322, is buried in Dunfermline abbey. I share my constituents' pride in the city's architecture, which includes our very own Carnegie hall, donated by Andrew Carnegie, the most celebrated of Dunfermline's sons. Many visitors enjoy a stroll down the glen, which is maintained by bonds donated by Andrew Carnegie. Dunfermline, like many cities, has had its ups and downs. Daniel Defoe commented in the 18th century that it showed the "full perfection of decay". The city is not in such a plight today, but many parts are run-down, with the old Co-op site blighting our city centre. That is a cause that I intend to take up on behalf of my constituents. Dunfermline was once a magnet for Scotland, and I believe that, in time, it can become so again.
	One advantage of fighting a by-election is that it draws in political representatives of all the major parties form all parts of the country. Never has Dunfermline seen so many MPs, including my party's three excellent leadership contenders. It seems that visitors were struck, as I have always been, by the landscape, the history of the city and the friendliness of the people. I am sure that that is the only explanation for the fact that so many Labour Members missed the vote on the Racial and Religious Hatred Bill. I certainly hope that the right hon. Member for Witney (Mr. Cameron) enjoyed his visit to Dunfermline high street. My Liberal Democrat colleagues look forward to welcoming him to their constituencies, following the dramatic effect of his visit to my constituency on the Conservative vote.
	The constituency reaches as far west as Kincardine, which will soon have a second crossing across the Forth thanks to investment by my colleagues in the Scottish Executive. In fact, the decision to invest in the second crossing was announced by my good friend and leader of the Scottish Liberal Democrats, Nicol Stephen. I thank Nicol for his tremendous support during the by-election. He is an excellent leader with all the drive, enthusiasm and intellect that one could hope for. However, Nicol is not the only leader who has connections with Kincardine. I am sure that the hon. Member for Banff and Buchan (Mr. Salmond) will recall our meeting in the village café on polling day. Unlike now, he looked surprisingly optimistic.
	The iconic Forth bridge connects my consistency with that of another Liberal Democrat, my hon. Friend the Member for Edinburgh, West (John Barrett). Hon. Members will know that the 1.5 mile-long bridge is the world's first major steel bridge. It has a balanced cantilever design, and its gigantic girder, with a span of more than 500 m, ranks as one of the great feats of civilization. From the top of the bridge—and I know—the views of the constituency are stunning. We are fortunate to have a rich diversity of attractions and entertainment. Fordell Firs is the national scout activity centre, and it is widely used by schools and youth groups as well. Just up the road is the Scottish base of the Mines Rescue Service, with an international reputation that we must support and protect. In Dunfermline itself, a new venture called Ceramic Experience brings out the creative potential of children from a very young age. In the north, Knockhill attracts bike and racing car enthusiasts from all over the country. Run by dedicated volunteers, the Scottish vintage bus museum is now acknowledged as a focal point for historic bus restoration.
	My constituency has a rich athletic heritage, with three excellent clubs. Pitreavie, which is celebrating its 50th anniversary, is rightly proud of international athletes such as Linsey McDonald and Ian Mackie. Dunfermline and West Fife coach Jimmy Bryce has a long record of nurturing young talent, but perhaps his latest find, Gemma Nicol, could be the most promising. Finally, my own club, Carnegie Harriers, has some first-class road and hill runners, including young John Hargreaves from my own village of Kelty.
	Dunfermline is proud to be a home for many important businesses. The Dunfermline building society retains its strong links with the city, which houses its headquarters. Although it has experienced significant decline, Rosyth dockyard is still a major employer, and I am determined to ensure that that remains the case for many years to come.
	On the subject of employment, I am very disappointed with yesterday's decision to axe 142 jobs from D. M. Crombie, and I am seeking to meet the Minister of State, Ministry of Defence, the right hon.   Member for East Kilbride, Strathaven and Lesmahagow (Mr. Ingram), to discuss the decision. Following the loss of hundreds of jobs at Lexmark and Simclar, I am determined to help those employees and to work toward bringing new high-value jobs to the constituency.
	I can honestly say that Dunfermline and West Fife is a great constituency and one that I am honoured to represent. I can today pledge that I will serve all of my constituents—no matter on which side of the House they sit.
	Many of my constituents will be interested to hear our debate on cancer services. It is particularly fitting that I make my maiden speech in this debate, as Rachel Squire had a long and brave battle against a brain tumour. I am sure that everyone in this House will have been affected by cancer in some way or another—a friend, family or even themselves. More than 130,000 people die from cancer in the UK every year. It is an illness that takes life in such a brutal manner.
	This week, I was pleased to be able to sign early-day motion 1696 on action mesothelioma day. Members will know that mesothelioma is an incurable asbestos-related cancer. It can develop 30 or 40 years after a person has come into contact with asbestos, which was widely used in the shipbuilding industry until the late 1970s. Many people predict that the epidemic will peak in around 2020. Its dockyard and ship-breaking heritage makes my constituency a national hotspot for mesothelioma. As reported in last week's Dunfermline Press, Dr. Colin Selby, a chest specialist at the local hospital, has warned that between 200 and 300 men could die in West Fife from the condition each year. At the moment, many men have not even heard of it. I am therefore grateful to the Dunfermline Press and to the British Lung Foundation for helping to raise awareness of this crippling disease.
	During my election I campaigned on four key issues. First, I led the effort against the proposed increases in tolls on the Forth road bridge. We need to provide public transport alternatives to the various parts of Lothian for our commuters who are currently forced to use their cars. I look forward to working with others on developing a sustainable transport strategy for this major artery.
	Secondly, I said that I would work with local health campaigners on the future of our local hospital, the Queen Margaret. We need to explore how much major elective surgery can take place there. I would like a waiting times unit to be developed at the hospital to conduct hip replacements and the like. I am pleased to say that I have already met people from the hospital and the local health board to advance that agenda.
	Thirdly, many local people feel frustrated about the state of our city centre. I have pledged to press all those responsible for a revitalised city centre of which we can all be proud.
	Finally, despite the best efforts of teachers, standards in our primary schools are below the national average. Our secondary schools are too large. We need a new secondary school for the West Fife villages, and I want to help to reduce the size of our secondary schools overall.
	My constituents have sent me to Westminster to represent their concerns and to fight for their interests. They have placed their trust in me and I will not let them down.

Sharon Hodgson: I congratulate the hon. Member for Dunfermline and West Fife (Willie Rennie) on his excellent maiden speech. As a new Member—I was elected only last year—I know how scary it can be to stand here and make a speech for the first time. He did it with some flair and I am sure that he will never forget the occasion. Having all his pals around him is no bad thing. It is also rather nice that they seem to be staying to listen to my speech. I thank them for that.

Jim Devine: I, too, welcome the hon. Member for Dunfermline and West Fife (Willie Rennie). It is a pleasure to have him here, although it is obviously a pity that the Labour party candidate did not win. However, for me, as the last by-election victor, it will be a pleasure not to be known as, "Jim Devine, the new Labour MP for Livingston".

Sharon Hodgson: I must continue with the happy tone by congratulating the Government on their fantastic record of investment in cancer services, especially the first cancer plan, which we have discussed. It was published in 2000—[Interruption.] I see that some of the Liberal Democrats are leaving now. The plan has meant that more funding than ever has been pumped into cancer services—an extra £280 million in 2001–02, increasing to £570 million in 2003–04. I do not have the most recent figure but I am sure that it is even higher.
	I must also draw attention to our fantastic record on waiting times, which have been reduced to two weeks to be seen by a specialist, a month for diagnosis and two months for treatment. That cannot go without recognition in the debate.
	I am sure that the hon. Member for Dunfermline and West Fife, as a new Member, will be asked in what he will specialise. I gave many answers to that question as the weeks went on. I had no idea in what I would specialise, although I had many interests and many important matters came my way. However, the decision was taken out of my hands when my best friend, Joanne Smith, was diagnosed with breast cancer at the age of 34. At the time, she had a two-year-old and a seven-year-old, who are now a little older—one has had a birthday since then—but she was a young woman with a young family. The diagnosis was a tragedy, which has totally coloured my first year as a Member of Parliament.
	Joanne was seen within 48 hours by a cancer specialist at my local hospital, the Queen Elizabeth hospital. Her consultant, Dr. Clark, has been incredible and her treatment has been fantastic. She had a double mastectomy and a terrible course of chemotherapy, which debilitated her. Nobody goes through chemotherapy lightly, but because she was so young she had to have such a high dose that it was shocking to see her suffer through it.
	I immediately began campaigning for herceptin and joined the all-party group that my hon. Friend the Member for Norwich, North (Dr. Gibson) mentioned earlier. I was keen to get my local cancer network—the northern cancer network—to reverse its decision not to prescribe herceptin. It made the decision because the drug did not have National Institute for Health and Clinical Excellence guidance. However, after campaigns by me and other hon. Members throughout the country and the region, the decision was reversed. When I asked why the network had reversed it, it cited the comments by my right hon. Friend the Secretary of State that lack of NICE guidance should not be an excuse for not prescribing the drug and that it was up to individual PCTs.
	The PCTs in my area recognise that they have the freedom to make such decisions, but they do not do that in practice because they defer to the northern cancer network. When one questions the northern cancer network, one finds that it defers to NICE guidance. So, although individual PCTs can make these decisions, in practice they do not.

Philip Dunne: Is the hon. Lady aware that the "Herceptin for Shropshire" campaign was launched in the Shropshire County primary care trust area today, as my hon. Friend the Member for North Shropshire (Mr. Paterson) mentioned earlier? The campaign is being led by a number of ladies in similar circumstances to those of the hon. Lady's friend, who have a particular reason to secure that support. It is important that they should continue to press the PCT to secure the funding, because, as the Secretary of State has said, she is prepared to allow it to take place.

Sharon Hodgson: I have some ideas on funding, and I want to open up a debate on that whole issue. I shall come to that in a moment. We just have to keep pressing the individual PCTs and reminding them that they have the ability to take these decisions, regardless of the budgetary pressures that they are under. We are pumping in lots of money for cancer services, and they must spend it wisely. However, I am told that they often choose to spend money that they had allocated for cancer services on other equally pressing things. It is up to everyone involved in this debate to insist that that money is spent on cancer treatment.

Susan Kramer: The hon. Lady has touched on the issue of funding. Is she aware that many people who suspect that they might have cancer are having to go privately to get diagnostic scans, because their GPs are so hesitant to spend their money on scans? The GPs are telling them that they have to go down other routes, such as consulting nutritionists or osteopaths, rather than sending them directly for a scan diagnosis. I am told that, in my area, only 40 per cent. of such patients are referred for a scan by their GP, because of funding issues.

Sharon Hodgson: The hon. Lady makes a good point, but time is short, so I must press on.
	My campaign with my friend got a lot of press interest, and the northern cancer network reversed its decision, on which I congratulate it. My friend started her herceptin treatment two weeks ago. She is one of the first people in the region to receive it.
	I want to talk briefly about brain tumours, which relates to the hon. Member for Dunfermline and West Fife, whose predecessor, Rachel Squire, sadly died after suffering from a brain tumour. Some other famous people who have suffered from brain tumours are Bob Marley, Elizabeth Taylor, Mo Mowlam and Sir Stamford Raffles. Such tumours account for one death in every 100. Someone who is not as famous as those people is a constituent of mine who is quite dear to my heart. His name is Fred Fergus, and I have been campaigning on his behalf for access to the drug temozolomide, which is awaiting NICE's approval. We were told that that would be decided by the end of the year, but I recently received some information on an appraisal consultation document—an ACD—put out by NICE. Apparently, NICE is recommending that the therapy should not be provided on a subsidised basis on the NHS in England and Wales for patients with newly diagnosed, high-grade malignant brain tumours. Perhaps the Minister will tell the House why.

Vera Baird: My hon. Friend has been involved in two campaigns. I was involved in one in Redcar relating to a drug called alimta, which has been licensed but not NICE-ed, as it were. It is used to treat mesothelioma, which is a terminal illness. NICE was not even going to evaluate it until October 2007, but that was useless for the men suffering from the disease who had only months to live. However, NICE is now introducing a fast-track procedure. When the Minister responds to the debate, will she tell the House whether it is intended that all cancer drugs should go through that procedure?

Sharon Hodgson: I thank my hon. and learned Friend for that intervention.
	Mr. Fergus is receiving his radiotherapy on the NHSand paying privately for a prescription of temozolomide. He says that it has given him his life back. There has been such a change in him in terms of memory since he has had access to the drug. Obviously, brain tumours affect the brain and memory, but with this drug he can function so much better, which is why I am so concerned about NICE perhaps not approving it.
	I want to move on to another very sad case involving a bowel cancer sufferer. Bowel cancer is responsible for 50 deaths a day in the UK, and it claimed the life of my constituent, Jack Wilson, at the age of 66. He was a retired miner who was hoping to get the drug cetuximab on the NHS. Again, he was told that the drug was not approved. I have already mentioned the northern cancer network and the process we go through there.
	I am short of time, so I should say that I want an urgent review of the funding of cancer treatments. As the hon. Member for Northavon (Steve Webb) said, there will be another drug, then another and another. More and more are on the horizon and we will have to try to fund them. Taxpayers are entitled to receive the best possible treatment and value for money from the NHS, so we need to examine how such treatments can be financed while retaining the tax base of the NHS and the principle that health care should be free at the point of need.
	There is a specific problem with funding drug treatments—the hon. Gentleman also mentioned this—while they are licensed but before they are NICE approved. There is a strong case for a dedicated cancer charity that would fund specific cancer drugs during that interim period. Also, there should perhaps be a dedicated lottery card. I shall leave those thoughts with the Minister.

James Duddridge: First, I congratulate the new hon. Member for Dunfermline and West Fife (Willie Rennie), who said that this is a bewildering place initially. I must admit, as one who continues to consider himself a new Member, that it is bewildering still. I spoke to my Whip only a few minutes ago, and he bewildered me further. However, I understand that I have a few minutes to make some comments on the important matter of cancer, having already written off my career.
	My predecessor, Sir Teddy Taylor, introduced an Adjournment debate in February 2002 on the subject of cancer care in south Essex, supported by my good friend and colleague my hon. Friend the Member for Southend, West (Mr. Amess) and by my hon. Friends the Members for Castle Point (Bob Spink) and for Rayleigh (Mr. Francois), who spoke earlier on the issue that I want to raise: the size of the cancer networks.
	Some three or four years ago, when my predecessor raised the issue, he was very concerned that cancer networks had to involve a population of more than 1 million. In south Essex, the population is only about 700,000 and we were to be merged with neighbouring areas. The cancer tsar, Mike Richards, came down, had a look and said that although we have a small population, the number of operations is large—indeed, as large, if not larger, than that of some cancer networks with more than 1 million people.
	In addition, south Essex is quite densely populated, but does not have good traffic infrastructure. It would be particularly difficult for patients to get out of the existing south Essex area for care. Like many Members, I have close family who have experienced cancer: my grandmother in her later years had breast cancer and received excellent care from Macmillan Cancer Relief.

Greg Hands: On the subject of Macmillan Cancer Relief, does my hon. Friend share my concern that nursing specialists in the Hammersmith hospitals NHS trust have been threatened with a move to general ward work from specialist oncology and palliative care, and that one of the two Macmillan counsellors is under threat of redundancy? All of that is due to a large NHS deficit.

James Duddridge: I thank my hon. Friend for raising that point. I am horrified that that is the case—my grandmother received excellent care—and I believe that Macmillan Cancer Relief's head office is in his constituency.
	It is important that south Essex keeps its cancer network. It is like "Groundhog Day" in that the Southend Echo, my local newspaper, ran a "hands off our cancer centre" campaign at the time when Sir Teddy Taylor raised the issue, and is now running a "save our cancer centre" campaign. The cancer network believes that it is the right size and does not believe that the cancer centre should be merged, although admittedly it has a number of other reasons. The consultation on the south Essex cancer care centre ends on 13 March, and I and several of my parliamentary neighbours will present quite a large petition signed by a number of constituents.
	To my mind, it is bizarre that we are told locally that this is just a small, structural, management change, and that only a small number of people will be affected this time round—as few as 20 or 30. We are deeply concerned, however, that once we are merged into a larger area including Anglia, more intermediate care cancer services, as well as specialist care, will be moved further and further away. Increasingly, with bad transport infrastructure, that journey will be two hours plus. While that might be acceptable for a one-off appointment, it is not acceptable in cases of cancer with many repeat appointments.
	South Essex also faces a problem with the number of consultations. The strategic health authority has assured me that it will consult again if some other cancer services are moved elsewhere within an expanded network. Consultations always seem to be short, however. My hon. Friend the Member for Rayleigh is co-ordinating a consultation on the police that has been rushed through. On health services alone, six consultation processes, which kicked off in December, will end in the next few weeks. There is a degree of consultation overload.
	If the local cancer network wants to remain as it is, and if local people who have been either writing to the Southend Echo or signing our petitions at pharmacists and doctors' surgeries say overwhelmingly that they do not want a merger, with the long distances involved, will the Minister assure us that we will be able to say to the local strategic health authority that, having gone through the consultation, people overwhelmingly want the network to remain as it is? My grandmother was in Bristol, not Southend. Her quality of life was appalling in her final years, despite the services provided by Macmillan Cancer Relief, and I fear what her quality of life would have been if she had had to travel for two hours every day.
	Despite problems with the local bus and train service, people in Southend can still get to Southend hospital relatively easily, and they would be grateful for an assurance that if all the parties in the consultation call for no change, there will be no change. Let us not go through all of this again in three years—when I hope that I will still be the MP—if the issue arises once more. My predecessor seemed to have dealt with it. Sadly, that is not the case. I seek the Minister's reassurance.

Stephen O'Brien: First, let me associate myself and my right hon. and hon. Friends with the Secretary of State's generous remarks about Gregor MacKay, whose memorial event is taking place today. We all pay great tribute to the work that he did for us as a colleague, and indeed to his many friendships across the political divide. We pay equal tribute to Linda Smith. We have been debating a terrible disease that afflicts so many—that, indeed, afflicts almost everyone in the country, at least indirectly, in our minds. That applies particularly to someone who was so public, so much loved, and such a wonderful comedienne.
	I congratulate the hon. Member for Dunfermline and West Fife (Willie Rennie) on an extremely good maiden speech. As the last Conservative by-election winner—some years ago—I am glad to be able to congratulate the most recent Liberal Democrat by-election winner. I met many of my future colleagues on the streets of my constituency: 200 Labour Members. As it happens, the debate in which I made my maiden speech was very well attended, although I hasten to say that that was nothing to do with me. At least 400 Members present who had worked their socks off to try to ensure that I did not arrive here had to listen to my speech. I therefore had considerable sympathy with the hon. Gentleman when he described his experience. I also thought that he spoke very movingly about the experience of stepping into the shoes of a much-respected Member, Rachel Squire, who sadly succumbed to the brain tumour that she had borne so bravely. That is particularly sad in the context of today's debate. In many respects it is a highly appropriate debate—and it is for another day for us to make any points about a Scottish Member seeking to involve himself in a debate that relates only to England.

Tom Harris: Quit while you are ahead.

Stephen O'Brien: Given that the hon. Gentleman, who is the Secretary of State's Parliamentary Private Secretary, is the only other Scottish Member who has been present for most of the debate, it is a shame that he has made his presence felt from a sedentary position.
	The hon. Member for Dunfermline and West Fife gave us a wonderful and engaging tour of his constituency. I am sure that his constituents look forward to his serving them with all his energy and enthusiasm. I fear that he will have to rely on the Official Report to ensure that his most notable and, I predict, his most challenging constituent, the Chancellor of the Exchequer—who, for some reason, was not present for his speech—recognises what a marvellous new Member of Parliament he has.
	I am glad that the Secretary of State congratulated the Opposition on making this vital subject a priority for their precious time. The debate has been characterised by the concern, care and expertise brought to it by all who have had an opportunity to speak on behalf of their constituents. I am aware that tributes in the House often sound ritual, but I know that I am joined by my right hon. and hon. Friends, and indeed by Members throughout the House, in thanking the countless people in the NHS and beyond it who work tirelessly for and with those affected by cancer.
	My hon. Friend the Member for Billericay (Mr.   Baron) made an excellent and constructive opening speech. I could not help being rather amused by the Secretary of State's slight discomfort over having to take the politics out of the NHS, but we were serious about wanting to debate the future of cancer services as a high priority. We heard from many Members on both sides of the House. The hon. Member for Northavon (Steve Webb) talked about the possibility of securing much lower provider costs for the NHS. That is, of course, an important subject, but I was particularly interested in what he had to say about the herceptin issue. For the sake of brevity, I will give the source for everything that he said about it. It can be found in column 1062 of the 8 December edition of the Official Report, set out wonderfully by my hon. Friend the Member for South Cambridgeshire (Mr. Lansley). He is obviously grateful that it has been read into the record again.
	In a celebration of a local investment to which he wished to draw attention, the right hon. Member for Oxford, East (Mr. Smith) mentioned tariffs that have recently been imposed in a most incompetent manner. I think he found it difficult to refrain from mentioning that. However, he rightly highlighted the uncertainty that that is causing and the quick resolution that is required to clarify the matter. He asked whether the serious deficit in the Oxford Radcliffe Hospitals NHS Trust should be spread among others. He seemed to be shifting the debate as well as shifting the deficit, rather than dealing with the fundamental issue, which is vital to so many of the issues that we face in the NHS.
	The hon. Member for Norwich, North (Dr. Gibson), the chairman of the all-party group on cancer, as ever gave us an enthusiastic tour d'horizon of leading-edge scientific progress in this country. He advanced a wonderful argument for the success of our competitiveness internationally, intellectually and scientifically and then suggested that we get rid of competition. That was an interesting circular argument, which all of us will enjoy pondering once the Official Report is out.
	We heard movingly from my hon. Friend the Member for North Wiltshire (Mr. Gray), who gave his personal testimony, particularly in the light of the difficult and dreadful experience that his wife has been through. I was very pleased, as I am sure all hon. Members were on both sides of the House, to hear that she has been given a clean bill of health and continues to receive the follow-on treatment. He made the important point, which we have sought to emphasise, that it is to the benefit of patients and to the subject as a whole that we take great care not to make it deliberately a party political issue when we look at the opportunities to improve outcomes for cancer survival and treatment.
	We also heard from my hon. Friend the Member for Rochford and Southend, East (James Duddridge). Apart from the slightly interesting start, when he called his Whip bewildering, which struck me as instant career death, he spoke powerfully and made a cogent case on behalf of himself and my hon. Friends the Members for Southend, West (Mr. Amess), for Castle Point (Bob Spink) and for Rayleigh (Mr. Francois) about the cancer network, and what the appropriate size is for the South Essex cancer care centre, considering local conditions. I hope that people at both national and local decision-making levels have taken due account of that strong and well-made case.
	We also heard from the hon. Member for Gateshead, East and Washington, West (Mrs. Hodgson)—that is certainly one of the most confusing constituency titles, with half of each city in it. She said that she spent some time deciding what to specialise in. I felt that she spoke sensitively about her experience as a result of the breast cancer of her friend. The House was helped by hearing of that experience.
	Looking at the future, we have to be clear where things stand today. As my hon. Friend the Member for Billericay said in relation to cancer care services, the present situation is unacceptable. There has been investment and continuing improvements, the Organisation for Economic Co-operation and Development has confirmed that the trend was already well established before this Government took over nine years ago, but—here is the big but—after nine years, survival rates are still among the worst in Europe, and significant inequalities of outcome persist in the UK. According to the Public Accounts Committee report, those inequalities are widening, not narrowing.
	As we have heard today, difficulties have arisen following the Government's efforts to focus targets on reducing waiting times—the front end of the patient pathway. That has led to neglect of later treatment. We face a serious issue: once a patient is on the pathway, the pipeline of time is extending. There is a serious issue in respect of how to deal with the problem involving radiographers.
	It was interesting to note that the future of cancer services is threatened because of the NHS's ballooning deficits. Will the Minister answer the excellent question from the hon. and learned Member for Redcar (Vera Baird) and confirm that there is no diminution or delay regarding the announcement from the Minister of State, Department of Health, the hon. Member for Doncaster, Central (Ms Winterton), as recently as August last year of a £37.5 million bowel cancer screening programme, which was confirmed just 30 days ago? Will she confirm that it will be up and running in April with five centres, not just one, as is being hinted as part of the financial cuts?
	In addition to issues such as waiting times, the size of the work force, the new requirements for benchmarking and the exchange of information—so that clinicians, who are best placed to make such judgments, can draw on the very best of existing practice—there is another big issue that we need to concentrate on. The Secretary of State has had some time in which to deal with the herceptin issue. On the question of the announcement that she made in October, even if she is arguing that she did not say that she would end the postcode lottery for early-stage breast cancer and that there was no change, therefore, in her Department's policy, one is still left with the following question. Why on earth did she make the statement that she made in October, unless it was made on the ground of cost?
	We were determined to raise today on the Floor of the House the future of cancer care services, because it is a priority. Such services need not merely to be maintained: the trends need to be enhanced, given the debilitating effect that cancer has on so many people in this country. At the moment, the opportunities to enhance the services available are being missed.

Jane Kennedy: This has been a very interesting and useful debate, which the hon. Member for Billericay (Mr. Baron) opened very disarmingly. It is much easier to respond to a straightforward political discussion across the Dispatch Box, but this has been a very thoughtful debate and, in the short time available, I shall try to respond in a way that reflects that fact, and to answer as many questions as I can.
	The cancer plan is a 10-year national strategy of investment and reform, the purpose of which is to reorganise, standardise and rejuvenate cancer services. We are just past the halfway point in implementing it, and looking back—it is appropriate that we do so—I challenge anyone not to acknowledge the clear and impressive story of real improvement. The hon. Member for Northavon (Steve Webb) asked when the next cancer plan will come along. There have been three reviews of the current plan and we may or may not have a further one. I take his point about wanting early warning of when another cancer plan will be considered, but that is some way down the track.
	My right hon. Friend the Secretary of State spoke of the importance of prevention, detection, treatment and care. I do not want to repeat what she said, other than to say that unprecedented investment in new and replacement equipment is helping to improve reliability and access to diagnosis and treatment. We are expanding the cancer work force—I will not repeat the figures, which are in the amendment—and there are more cancer specialists. New training programmes for specialties such as radiography and endoscopy are increasing capacity. Such investment is going hand in hand with reform. Specialist teams have been established across the country that bring together surgeons, radiologists, pathologists, nurse specialists and many others to deliver co-ordinated care to patients in hospitals.
	That brings me to the Opposition's motion, and I have to say that I agree with a lot—indeed, almost all—of it. It is very much in keeping with the opening speech of the hon. Member for Billericay, but I disagree profoundly with the suggestion that we now need a different approach if we are to make further improvements in cancer services. It is appropriate that I deal with this issue specifically. We are close to being the world leader in developing the multidisciplinary approach that I have just described. All these advances are due largely to the cancer plan and to the work of Professor Mike Richards, as my right hon. Friend the Secretary of State said.
	The hon. Member for Billericay discussed at length how the guidance and appraisals of the National Institute for Health and Clinical Excellence should be enforceable, and a number of Members referred to Herceptin and the role of NICE. When I first came into post last summer, the question arose of the length of time that NICE is taking on this issue. We issued a written statement today outlining the exact process for herceptin, but we must remember that the licensing process—which is very important for this treatment and its application—and the NICE appraisal process are absolutely critical in allowing the health service to take proper decisions on how it uses its resources locally to provide the proper available medicines and treatments. We trust NICE, as an independent organisation, to make those appraisals and to assess the new treatments. It does so in a way that is very efficient and highly regarded throughout the world.

Mark Pritchard: Will the Minister give way?

Ian Liddell-Grainger: Will the Minister give way?

Jane Kennedy: I hesitate to give way, as I am very pressed for time, and there is a lot that I must respond to. I must tell the House that I resist the call to give NICE more powers and to change how it works, especially before it has had the opportunity to go through the appraisal process.
	I very much welcomed NICE's willingness to embrace a new, single-technology appraisal process, especially given the strong defence made for its solid work in the past. My hon. and learned Friend the Member for Redcar (Vera Baird) asked whether that meant that all new cancer drugs will be subjected to the new, single-technology appraisal process. My quick answer is no: some new drugs will be taken alongside other treatments and medicines, and their numbers mean that they will have to go through the slightly longer process.
	However, the process is critical for a drug such as Herceptin, which has serious side-effects. Quite rightly, the NHS needs the best possible advice that it can get in respect of such medicines.

John Baron: I do not disagree with much of what the Minister says, but the bottom line is that the postcode lottery will still apply if the system continues to be run as it is at present. Cost assessments running alongside the appraisals would ensure that what was recommended could be afforded. That is what happens north of the border, for example, but the postcode lottery will continue to operate in the absence of such assessments

Jane Kennedy: The so-called postcode lottery applies only in the period when we are waiting for a treatment to be licensed. Once NICE approval has been given, theNHS has 90 days—three months—to make arrangements for provision of the medicine. I shall look in detail at the example to which the hon. Gentleman has drawn my attention, and see what can be done.
	The hon. Member for Billericay mentioned the length of time that people have to wait for radiotherapy. He made far too many points for me to answer in the time remaining, but I can tell the House that the Royal College of Radiologists published an audit on 23 February that showed that the situation is improving. However, I accept the criticisms that have been made, and much remains to be done in this regard.
	Even so, I am pleased to be able to tell the House that the Department of Health has exceeded its target of recruiting an extra 1,000 radiographers. More than 1,400 additional radiographers and radiography assistants are now working in the NHS, compared with 2003. That is still not enough: a lot of progress has been made, but we recognise that more remains to be done.
	The hon. Member for Northavon raised a number of points, and asked about the cost of herceptin. He will be interested to know that the new pharmaceutical price regulation scheme agreement that started in January 2005 will save the NHS more than £1.8 billion on branded prescription medicines over a five-year period. The detail of his question concerned whether the company Roche was offering anything at the moment. Although I cannot comment on that, it is an interesting thought, and I shall be happy to write to him about the matter. Many hon. Members said that the process was arbitrary, but in the long run I do not believe that tinkering with what happens before NICE gets involved will benefit the NHS in any way.
	My right hon. Friend the Member for Oxford, East (Mr. Smith) works tirelessly for his constituents. As he said, quite rightly, he holds the health staff in his town in very high esteem, and I want to answer a couple of the specific points that he raised. He asked whether the tariff applied to cancer services. Under the payment by results programme, hospitals are paid according to the number and complexity of the cases treated. Chemotherapy, radiotherapy and, indeed, palliative care will eventually be included, but they are not included at present, and are treated as specialist services for the purpose of commissioning. I would be happy to talk to my right hon. Friend about the deficits that he described in Oxford on another occasion.
	The hon. Member for North Wiltshire (Mr. Gray) tempted me to be party political, but I shall just echo the words that have been said about his wife and the fact that she has made a full recovery. I am also pleased to hear that her personal experience of the service provided by the health service was good. My hon. Friend the Member for Norwich, North (Dr. Gibson)—

Patrick McLoughlin: rose in his place and claimed to move, That the Question be now put.
	Question, That the Question be now put, put and agreed to.

Question put accordingly, That the original words stand part of the Question:—
	The House divided: Ayes 228, Noes 294.

Question accordingly negatived.
	Question, That the proposed words be there added, put forthwith, pursuant to Standing Order No. 31 (Questions on amendments), and agreed to.
	Mr. Deputy Speaker forthwith declared the main Question, as amended, to be agreed to.
	Resolved,
	That this House recognises that the Government has made the improvement of cancer services a key priority through the implementation of the NHS Cancer Plan which sets out to reorganise and rejuvenate cancer services and has provided the NHS with investment to modernise these services; welcomes the achievements set out in the recent Public Accounts Committee report, the NHS Cancer Plan: a progress report, which acknowledged that significant progress has been made across the country; notes that the total death rate for cancer in people under 75 has fallen by 14 per cent. since 1996; acknowledges that under this Government unprecedented investment in equipment is helping to improve both access to, and reliability of, diagnosis and treatment; further notes that specialist teams have been established across the country to help deliver co-ordinated care to patients in hospitals; further welcomes the fact that the National Institute for Health and Clinical Excellence is introducing a new fast track assessment process to enable them to issue binding advice to the NHS on the most important new drugs within weeks of them receiving a licence; further notes that this Government has commissioned research to enable initiatives to raise awareness of the symptoms of cancer to be targeted on people most at risk; further notes that there has been a 43 per cent. increase in cancer consultants since 1997; acknowledges that there has been a 40 per cent. increase in cancers detected through breast screening; and further welcomes the Government's commitment to continuing to deliver the commitments in the NHS Cancer Plan.

Mr. Deputy Speaker: Order. If Members are leaving the Chamber, they should do so quietly and, hopefully, in ones or twos, rather than like a football crowd. That will allow us to get on with the next items of business.

DELEGATED LEGISLATION

Mr. Deputy Speaker: I propose to put together the Questions on motions 3 to 5.
	Motion made, and Question put forthwith, pursuant to Standing Order No. 118(6) (Standing Committees on Delegated Legislation),

Representation of the People

That the draft Representation of the People (England and Wales) (Amendment) Regulations 2006, which were laid before this House on 24th January, be approved.

Constitutional Law

That the draft National Assembly for Wales (Representation of the People) (Amendment) Order 2006, which was laid before this House on 24th January, be approved.

Representation of the People (Scotland)

That the draft Representation of the People (Scotland) (Amendment) Regulations 2006, which were laid before this House on 6th February, be approved.—[Mr. Heppell.]
	Question agreed to.

PETITIONS
	 — 
	Breast-feeding

David Kidney: I am pleased to support an organisation called The Way Nature Intended in presenting to Parliament a petition signed by just over 1,000 people and collected by breast-feeding support groups around the country to support a change to legislation to make it illegal to discriminate against mothers because of how they decide to feed their babies. There are several thousand more signatures to the same petition online, but Parliament currently does not accept web-based petitions.
	The petition states:
	The Petitioners therefore request that the House of Commons urge the Secretary of State for Health to take such measures as lie within her power to tackle any discrimination that prevents parents from feeding their babies at appropriate times in public places.
	And the Petitioners remain etc.
	To lie upon the Table.

Immigration, Asylum and Nationality Bill

David Lepper: The petition is from the Brighton and Hove Chinese Society and has 92 signatures.
	The petition
	Declares that the Petitioners object to the new 'Immigration, Asylum and Nationality Bill' and the five year strategy for 'asylum and immigration, Controlling our borders: Making migration work for Britain'. The petitioners strongly believe that eliminating the applicant's right to appeal is against our human rights and is a very unfair act.
	The Petitioners therefore request that the House of Commons urge the Government to amend three areas of the new Bill, which are:
	1.   The removal of in country appeal rights and removal of entry clearance appeal rights
	2.   Employer's duties in relation to their workers
	3.   The new points system affecting settlement rights
	To lie upon the Table.

Planning Application (Canvey Island)

Bob Spink: The trend in the south-east now seems to be for blocks of flats to be shoehorned into very small places. That has a number of consequences: it maximises developers' profits and it suits the Office of the Deputy Prime Minister, which is trying to cram more houses into the south-east, but it has negative consequences for local communities, particularly as it places great stress on their infrastructure. This petition relates to such a case, and I pay tribute to Mr. and Mrs. Archer and Paul Bailey, who organised it, and to all who signed it.
	The petition states:
	To the House of Commons
	The Petition of the residents of Canvey Island and others,
	Declares that the petitioners are deeply concerned about the application to build 12 flats at the corner of Somnes Avenue and Maple Avenue on Canvey Island because the area is already overdeveloped for the infrastructure that exists and these flats would be served with totally insufficient car parking spaces and by Leige Avenue access road that is entirely inadequate and this would cause great disruption and inconvenience to all residents and create a major traffic accident area.
	The Petitioners therefore request that the House of Commons call upon the Government to urge Castle Point Borough Councillors to reject this application.
	And the Petitioners remain, etc.
	To lie upon the Table.

LOCAL PRESS OWNERSHIP

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Heppell.]

Mr. Deputy Speaker: Before I call the hon. Member for Great Grimsby (Mr. Mitchell), I just say to the Minister and the House that the hon. Gentleman is seriously incapacitated and is being given special dispensation to remain seated while he addresses the House this evening.

Austin Mitchell: Thank you, Mr. Deputy Speaker. I am most grateful for that permission to remain seated for entirely non-alcoholic reasons. I hope that it will not inhibit the ability of other Members to stand and applaud, as usual, during a speech on the Adjournment.
	I declare an interest, first, in that I am a member of the National Union of Journalists. Secondly, I, too, have been fired by the Yorkshire Post for, I assume, economic reasons; it could not have been because of the quality of the articles that I was writing. Thirdly, I am chair of the parliamentary NUJ group. The situation has slightly changed since I requested the debate, which is basically about job cuts in regional and provincial newspapers. The Daily Mail and General Trust's proposal to sell off Northcliffe Press, which has 113 titles, including the Grimsby Telegraph and the Scunthorpe Telegraph, has now been postponed pro tem.
	I wonder whether that is because I wrote to Lord Rothermere personally to advise him against the move. Although I do not like Northcliffe's politics in any way, it is one of the better organised groups and it has always been more concerned with quality, journalistic standards, training and the appointment of good editors—certainly at the Grimsby Telegraph—within the group. Grimsby has always had a good quality local evening paper, so I did not want the young Lord Rothermere to be misled by City slickers advising, as they usually do because of the fees that they get, "Sell and acquire," or by the conmen who often cluster round powerful figures advising them to invest in new technology such as the dotcom bubble of a few years back and abandon what they are doing well. I was delighted that although Lord Rothermere's reply did not exactly say, "My God, Mitchell, you are quite right. Why didn't I think of that? Would you like a directorship?", the plans have been slightly postponed, and I hope that that will give us the power to fight another day in this matter.
	As an illustration of what is going on in the local press because of the preparations for the sale, Northcliffe's strategy involved a programme of redundancies and job losses. As the term goes, there was a "feeding down" of local newspapers to make them more profitable before selling them. The programme was called "Aim Higher", which journalists, with their usual cynicism, promptly called "Aim Fire". That involved getting rid of substantial numbers of journalists throughout the country to make the group more saleable.
	That process has been repeated in every newspaper group throughout the country. These days, provincial newspapers are basically in chains. They are born free, but everywhere they are in chains, and the chains are looking to profitability. Trinity Mirror has 230 titles. Last year, it made a profit of £172 million. It is proposing hundreds of redundancies. Newsquest was £700 million in profit last year. It has 216 titles. It has already fired 25 subs in Colchester and between 60 and 70 in Scotland. Johnston had a profit of £177 million last year. It has 283 titles. It has just closed its press in Scarborough. Archant made a profit of £332 million out of 80 titles and is firing 17 subs in Norfolk. Even The Guardian is going through this process. There will be hundreds, if not more than 1,000, job losses in provincial newspapers.
	This is being done at a time when the provincial press is profitable. It is said that it is being done because other advertising media—internet websites—will take revenue from other forms of profitable classified advertising, which provides about 50 per cent. of the revenue of local newspapers. If that were the motive, newspapers could always buy up the competition, as they bought up the free sheets. At present, regional newspapers are very profitable and becoming more profitable year on year. Profit margins are between 20 and 35 per cent. Those margins are higher than any margins in the local press in France, Germany, Europe generally and the United States. Advertising spending is increasing in local newspapers by 5.8 per cent. a year, and has increased every year for 13 years.
	It is not the fact that these newspapers are unprofitable and are thus subject to job losses. They are local monopolies that do not face competition, which would enforce higher spending, so they are able to reduce the numbers of journalists and to cut spending on staff generally. The other factor to take into account is the growing power of the newspaper chains that want to increase the rate of return that they pay to their shareholders. In fact, that is the main explanation for what is going on.
	The consequences of those job losses fall on the quality of the newspapers. Despite what some directors and, particularly, accountants seem to think, journalists do need newspapers, and newspapers need journalists. Newspapers cannot be produced without journalists. Cut the journalism and all else fails. That is a failure from which we all suffer, as does local democracy. There is less coverage of council meetings, less coverage of the courts and less coverage of all local bodies. There is less coverage of the arguments over, for example, academy schools. There is less discussion and less analysis of what is going on locally.

David Taylor: The Leicester Mercury is a Northcliffe newspaper, and an excellent one. One of the subjects that my hon. Friend has described is creeping out of its coverage—local issues at sub-county level are getting much less coverage, not least because such newspapers are in slow-managed circulation decline. Therefore, advertising is providing a higher proportion of income.

Austin Mitchell: That is going on throughout the country. It weakens local democracy and local newspapers. It also weakens local interest. There is less analysis of what we are doing. There is less discussion of politics; less discussion of what the local council is doing; and less discussion of what senior local figures do at local power centres.
	If one does not have the journalists on the required scale, fewer journalists cover stories. They do not go out—they stay in the office to cobble together press releases using the glossy spin that companies and institutions produce to say that they are doing well when, in fact, they are not. Those companies are concealing the truth, and the journalists conspire in that concealment. There are fewer specialists, including health specialists and even sports specialists. Spin wins—the truth does not prevail—and, as a result, the electorate is less well-informed.

David Drew: I am sure that in preparation for this debate my hon. Friend has read the Forest of Dean and Wye Valley Review, which usefully explains what is happening in my part of the world. The Citizen has been moved to Gloucestershire Echo territory which, as anyone who knows Gloucestershire will realise, is like revisiting the civil war. The Western Daily Press and the Evening Post are fine newspapers, but they have been pushed together. Journalists have been threatened with the sack, sub-editors have been removed and so on. Does my hon. Friend agree that that is not acceptable?

Austin Mitchell: I would give my hon. Friend a standing ovation if I were capable of standing to applaud him. It is a weakening of local influence and local information. It is a weakening of democratic debate in the localities at a time when we are desperately trying to strengthen local democracy and transfer power from London to the regions. There is talk of the new localism, communes and new local leadership groups, but local democratic debate will be harmed by the cutting of newspaper staff and reporters.

John McDonnell: In view of the success of my hon. Friend's correspondence with Lord Rothermere, may I invite him to write to the Hillingdon & Uxbridge Times, which is putting to the knife a number of journalistic and other jobs in my local area? That, too, will lead to the creation of a near-monopoly as one paper folds and another does not. Is not the true problem the fact that profitability is so high that obscene wage awards are given to chief executives? The chief executive of the Trinity Mirror group, Ms Sly Bailey, has slashed jobs in the past few months but earns a salary of £550,000 and gave herself a bonus of £495,000 this year.

Austin Mitchell: I agree that that is obscene, and it produces lethargy in the local press when we want dynamism, drive and competition. There can be no healthy local democracy without a healthy local media, particularly healthy, efficient and effective local papers staffed by good journalists who develop stories and provide information for people to make democratic decisions. The people suffer, and we suffer, because we cannot communicate our views and policies to the electorate. We cannot make the case for the kind of society that we want to achieve. Newspapers can always be sold if they are filled with sex, celebrities, the more interesting bits of Abi Titmuss and extruded pap in place of news. However, one cannot educate or inform the people on that basis, as one is peddling lies, which are blandished as spin in place of honest information, inquiry and serious analysis. One cannot build a healthy local democracy on that basis.
	The Under-Secretary of State for Trade and Industry, my hon. Friend the Member for Bradford, South (Mr. Sutcliffe), has the invidious job of responding to my tirade—his Department is the only one with any regulatory power in this field—and I hope that he accepts the need to look at the issue of profiteering by local monopolies. I hope that he will consider trying to give newspapers a different status in takeovers, and will try to restrict the growing power of the chains, which are attempting to push up profits. I hope that he will investigate with the Department for Culture, Media and Sport how we can encourage and increase diversity in our local newspapers and media, because that is the only healthy way to encourage local democracy.
	Localism is becoming extinct and centralisation is growing. High streets are dying, post offices are closing, and the whole world has been taken over by massive supermarkets. We need to bring democracy back to our people, and we can do that only with the help of the local media.

Gerry Sutcliffe: I congratulate my hon. Friend the Member for Great Grimsby (Mr. Mitchell) on securing this debate on a subject that is very close to his heart following his years in journalism and the media. I am happy that he had special dispensation this evening to remain in a sedentary position because of the recurrence of his old injury from a parachute jump 30 years ago. That shows how adventurous he can be. As he said, he is a member of the National Union of Journalists and chair of the NUJ group here in Parliament, which plays a positive role in trying to ensure that the news gets told as it should, not only in local journalism but in the national media. Unfortunately, that is not always the case.
	My hon. Friend focused on the role of provincial newspapers. I speak with some practical experience of that world. In my younger days, I worked for our local newspaper, the Bradford Telegraph and Argus, as a display advertising clerk. My role was to go up to the editor and explain how much space he had left for news, because the advertising revenue was important to the paper. Later on, I was a full-time trade union officer in the printing industry with the SOGAT union, so I am aware of the importance of local media to jobs in our communities. My hon. Friend is right to point to the importance of our having a healthy provincial newspaper sector.
	When this debate was announced, many hon. Members asked me to mention their newspapers, but there were so many that it would be impossible to do so. I therefore generalise by saying that the Grimsby Telegraph and the Scunthorpe Telegraph are important, as are the Hull Daily Mail and the Bradford Telegraph and Argus. I am sure that the others are as well.
	My hon. Friend talked about what happens when groups of newspapers come together and how that affects the quality of the journalism. I do not entirely share his sense of doom and gloom about that. Many local newspapers are finding innovative ways of communicating with their local communities. They have the basic product of the newspaper but are using other media to try to get the message across. The advantage that many local newspapers have is that they are a strong brand within their communities and are trusted on issues to do with local education, local government and so on. The brand name of a local newspaper, which has often been in the community for a long time, brings with it the view that it is caring for the community that it serves.
	The local press is a competitive world because of the diversification of the media that is taking place. It is important that newspapers try to find new, imaginative ways of reaching the public, whether through free newspapers or other media with which they can get involved. The Government are mindful of the importance of the media, particularly local media.
	The laws relating to local press ownership are found in the Broadcasting Act 1996, the Enterprise Act 2002 and the Communications Act 2003. Newspaper ownership, including local newspaper ownership, is regulated by rules under the Enterprise Act, as amended by the Communications Act. Cross-media ownership is regulated by the Broadcasting Act, again amended by the Communications Act. The ownership rules aim to avoid undue concentration of media ownership and to maintain diverse media content from a variety of sources. The Communications Act replaced the special merger regime for newspaper transfers under sections 57 to 62 of the Fair Trading Act 1973 with a simpler and more relaxed system.
	The Communications Act sought to deregulate when possible to promote competition and attract new investment. The Act removed the requirement for the Government to be pre-notified of all newspaper mergers. It also removed the requirement for the Secretary of State to make a decision only following a report from the Competition Commission. That was expected to generate cost savings for business and the Department of Trade and Industry. The Department previously charged a fee of £5,000 or £10,000, depending on the circulation, for considering the merger. A reference to the Competition Commission entailed an average cost of £300,000 and imposed extra costs on businesses.
	The more streamlined and less burdensome regime meant that the regulatory resources could be better focused on the transfers of newspapers that raise competition or plurality concerns. The new regime was aligned with the new system for general mergers that the Enterprise Act introduced.
	The Communications Act added new newspaper public interest considerations to the Enterprise Act, thereby enabling the Secretary of State to intervene in a case and, if necessary, to refer it to the Competition Commission when it raised concerns about the accurate presentation of news, the free expression of opinion or the plurality of views in newspapers in the UK or part of the UK.
	The main media ownership provisions of the Communications Act that related to newspapers were, at national level, the retention of existing limits on joint ownership of newspapers and Channel 3. At regional level, a parallel 20 per cent. rule was retained. No one who owns a regional Channel 3 licence may own more than 20 per cent. of the local regional newspaper market.
	The rules that apply to joint ownership of national newspapers and Channel 5 were removed. Locally, a limit was retained on the ownership of local radio stations by companies that control more than 50 per cent. of the newspaper market in the area of the radio service in question and companies that own a regional Channel 3 licence, whose coverage is, to a significant extent, the same as that of the radio service. Restrictions on radio ownership by newspaper companies with less than a 50 per cent. share were removed.
	I hope that my hon. Friend will recognise that the Government are concerned about those relationships and that we acknowledge the importance of local newspapers in their communities. We are also concerned about the impact on the quality of journalism.
	Like all hon. Members, I know from personal experience that many journalists who work on local newspapers do not stay for a long time—there is a high turnover of journalists in the local media. In some cases, that is due to promotions. In Westminster, there are many examples of Lobby journalists who come from local newspapers. The NUJ is especially concerned about the quality of young people who are attracted to the profession and ensuring that they have long and worthwhile careers.
	I note my hon. Friend's success with Lord Rothermere. I am sure that that is down to his personal performance in writing to Lord Rothermere and his distinguished career. I emphasise that we are keeping an eye on what is happening. The regulatory regime is in place if there are problems and we are always happy to hear from the NUJ and other bodies about their concerns about the quality of journalism.
	My hon. Friend is right to raise the subject and to ensure that we are all mindful of the quality that we receive from the local media. I hope that he will accept that we are prepared to consider the matter and to meet regularly to ascertain why there are problems.

John McDonnell: As secretary of the NUJ parliamentary group, I invite the Minister to meet us, when we would welcome the opportunity for him to meet delegations of some of the trade unionists from individual newspapers. As my hon. Friend the Member for Great Grimsby (Mr. Mitchell) said, the calculation is that 1,000 job losses have occurred in the sector in the past six months. It is an important sector and the scale of job losses is significant. We would welcome the opportunity for the Minister to experience at first hand the impact on people's employment.

Gerry Sutcliffe: That is a reasonable request, and I will be happy to do that for my hon. Friend. We will make arrangements, following this debate, to have such a meeting.

Patrick Cormack: I thank the Minister for giving way, and I am sorry that I missed the first three minutes of the debate. When he meets the group, will he try to make it an all-party group? There is concern on both sides of the House about this matter.

Gerry Sutcliffe: I recognise that point. I do not think that there is a party political nature to this debate. We are all aware of the impact of the local media on our communities. I should be happy for the meeting to involve Members from all parties, but it will be up to the members of the group to decide whom they invite for me to meet.
	This is an important debate, and there are many issues relating to diversification in the media. The printed media in particular face many challenges.

David Taylor: I am sure that the Minister will accept that the concerns about the Rothermere press that my hon. Friend the Member for Great Grimsby and others have raised this evening are not politically motivated. Its regional papers are scrupulously fair and balanced, not only in election periods but throughout the electoral cycle. At least, that is my experience in Leicestershire. We are making general and genuine principled points, not political ones.

Gerry Sutcliffe: I accept that, and I am not trying to denigrate any of the points that have been made. They have been well made, from the honest position of wanting to ensure that good quality journalism in our communities continues, and that the well-being of local newspapers continues. I am trying to explain that, within our enterprise and competition regime, we have the opportunity to deal with certain situations if we feel that they are not benefiting local areas.
	My hon. Friend the Member for Great Grimsby talked about buying from supermarkets rather than newsagents. The world is changing, in regard to the ways in which consumers acquire their information, whether it be through the printed media, radio, television or the internet. There is a whole variety of ways for news to reach us. This has been a worthwhile debate, and I hope that it will have positive consequences at our meeting. I also hope that the House accepts the position that I have put forward.
	Question put and agreed to.
	Adjourned accordingly at thirteen minutes to Eight o'clock.